Rush must have worn his exhaustion well.Only his old friend, John Adams, writing to his wife in mid-January, mentioned how tired he looked. But at that point it's not certain if his exhaustion could be attributed to the epidemic or to his continuing labors: newspaper controversy over the origin the epidemic, his medical school lectures in which he sought to destroy Kuhn, and his monumental memoir of the epidemic. In addition he and his family moved into a house at 98 South Fourth Street, just south of Walnut Street. And he continued to see patients and was fascinated how, just as Sydenham had shown over a century before, diseases coming after an epidemic took on many symptoms of that epidemic disease. The "constitution of the atmosphere," some as yet undiscovered quality of the air, made all diseases since September 10 inflammatory. Ironically, given the religious passion so evident in his letters during the epidemic, the one exertion Rush avoided was participating in the emotional debate over the effort to prevent a return of the epidemic by closing the theaters.
Rush was not the first to try to put the epidemic in perspective. Mathew Carey, one of the nation's leading publishers and book sellers, appreciated the value of getting a history of the ordeal in bookstores as soon as possible. On November 14 he published a 97 page tour de force describing the epidemic during which 4,044 people died (no one hazarded a guess as to how many died from yellow fever but in 1792, 1165 died of all causes in 12 months.) Margaret Morris sent it to friends and endorsed it as "a pretty good account of the late occurrences in our city." With four printings in three months and with each new edition including more names of those who died, Carey sold 10,000 copies.
In his introduction, Carey described the boom times of the city, replete with high rents and "alarming" luxury, and allowed that few "will pretend to deny that something was wanting to humble the pride of a city, which was running in full career, to the goal of prodigality and dissipation." That said, the rest of the book was a cordial to the city's reputable citizens. "Tipplers and drunkards," "fille de joie," and the poor especially suffered during the epidemic. Those in "dirty houses have severely expiated their neglect of cleanliness and decency...." He did criticize the general panic: "The old custom of shaking hands fell into such general disuse, that many were affronted at even the offer of the hand.... And many valued themselves highly on the skill and address with which they got to windward of every person they met." But in his discussions of the abandonment of the sick, he generalized. He specified acts of charity and honored heroes like Clarkson and Girard by name. Carey served on the Committee, save for the three weeks he was out of town on a trip to Virginia. He lauded his colleagues. He absolved those who fled the city from the charge of cowardice. By leaving they made the city safer for those who remained. There was more food available in the markets and less opportunity for contagion to take hold. "Although the proceedings of many people in Philadelphia have been strongly tinctured with cruelty, and a total dereliction of every principle of humanity," he concluded, "yet the general conduct has not been so revolting as in London during the plague."
The behavior of other cities earned sterner scrutiny - 22 pages of the 97 page text chronicled their insensitivity and the cruelty of their quarantines. As he wrote in mid-November, lies were still being spread impugning the health of the city in an effort to effect the city's "entire destruction." While he congratulated most segments of the Philadelphia community, Carey did take two swipes which, fortunately for a fuller picture of the epidemic, would elicit pamphlets in response. He thought church services had spread the disease and noted the great mortality in one of the most active congregations, Helmuth's German Lutheran Church, where 641 people were buried. Helmuth replied with a moving memoir of his sacrifices and noted that when other churches turned corpses away from their burial grounds, his buried all brought to its gate.
Prior to publication of his book, Carey had written a shorter history published in newspapers in mid-October. In that he had briefly mentioned the abandonment of patients in a way that might suggest that the black nurses were part of the hell, not the salvation of the city. Families "resigned" sick members "to the care of perhaps a single negro." Jones and Allen asked Rush to correct Carey's slight. He obliged and wrote to Carey describing the sacrifices of Allen, Jones and their associate William Grey in procuring nurses and burying the dead. "Many of the black nurses," Rush added, "it is true were ignorant, and some of them were negligent, but many of them did their duty to the sick with a degree of patience and tenderness that did them great credit." That blacks were not "exempted from the disorder" enhanced the merit of their service.
In his book Carey lauded the African American leaders, saying their services demanded "public gratitude," but he added that the great demand for nurses was "eagerly seized by some of the vilest of the blacks" to extort up to $5 a night for attending patients, and "some of them were even detected in plundering the houses of the sick." Plus "a hardened villain from a neighboring state formed a plot with some negroes to plunder houses." They were "seized and the company dissolved."
In reply Jones and Allen published a pamphlet that pointed out cases of extortion, robbery and cruelty by whites. They chronicled the sacrifices of blacks, including a strict accounting of the money spent by the Free African Society, and the disposition of all the beds the society was asked to bury temporarily as a means of disinfection. They told the nurses' side of the story. They were lured by ever spiraling wages, and still many served for next to nothing. What they had to put up with was almost insupportable at any wage. Many patients were "raging and frightful to behold; it has frequently required two persons to hold them from running away, others have made attempts to jump out of a window, in many chambers they were nailed down, and the door was kept locked, to prevent them from running away, or breaking their necks, others lay vomiting blood, and screaming enough to chill them with horror. Thus were many of the nurses circumstanced, alone, until the patient died, then called away to another scene of distress and... many of them having some of their dearest connections sick at the time, and suffering from want, while their husband, wife, father, mother, & c. have been engaged in the service of the white people."
Rush was not numbered among Carey's heroes and was mentioned solely as the author of the rotting coffee theory for the genesis of the disease. Carey disagreed and blamed the privateer Sans Culottes and her prize the Flora. The privateer's "filth was emptied at a wharf between Arch and Race Streets," and dead bodies were seen taken off the ships. Otherwise, medically speaking, "the whole of disorder, from its first appearance to its final close, has set human wisdom and calculation at defiance."
Perhaps it was Julia's return that calmed Rush down so that he did not immediately attack Carey with his customary acrimony. More likely, Rush understood that with the end of the epidemic, he could not justify hastily conceived pronouncements and attacks as necessary to save people from sickness and death. It was time to reassume his role as professor, and be sure that his proofs were sound and convincing. Others were quick to write to the newspapers attacking Carey on the issue, (and given the tenor of their rebuttals some evidently without Rush's coaching.)
James Vanuxem, who owned the Flora, asserted that no one on her nor on the Sans Culottes had been sick. The ships had come from Britain and France respectively, not the West Indies. It was true that a body had been removed from the Flora on July 27, but that Frenchman had been boarding on Water Street, where he got the fever. After being kicked out of his boarding house, he had come to Vanuxem's wharf, and was placed on the Flora's deck where he died in the night. Drs. Currie and Cathrall countered Vanuxem's letter with proof that the fever came from the Sans Culottes, Flora, or the Amelia. Every crewman of the Amelia, which came from Haiti, arrived sick; and Dr. Cathrall had treated one of the crew from the Sans Culottes, which had captured several other ships who had crew members with yellow fever. The doctors demonstrated how Mrs. Parkinson, Cathrall's first fever patient who died August 6, could have gotten the disease from a sick Frenchman. The evidence was conclusive: just as in 1762, the epidemic had come from the West Indies.
Rush's opponents soon introduced innuendo into the debate. "That the late mortal sickness was imported is now so generally known," a correspondent wrote, "that it requires more faith to believe the contrary supposition, than is perhaps required to move mountains." Of course, Rush's friends replied in kind. One noted that the Amelia was the ship that brought the damaged coffee which caused the disease once it rotted on the wharf. Those who believed otherwise were like "some Genoese seamen" who blamed the plague on "a ball of fire, which either burst out of the earth, or fell down from the heavens." Dr. James Mease pointed out that every seaman who got the fever had been exposed to the rotting coffee. Plus it was insulting to the late port physician, Hutchinson, to think that he would have let any sick seamen or passengers get into the port. Another writer reminded that Rush first recognized the epidemic and developed the best treatment, so it was best to wait for his promised proof for the local origins of the disease.
At the end of October the governor had asked the College of Physicians what caused the epidemic and how to prevent another. In mid-November the College, from which Rush had resigned, endorsed the importation theory. There was no evidence that yellow fever had ever been generated in the city or state, "but there have been frequent instances of its having been imported." They thought it had come to the city in some vessels after the middle of July. Quarantines could prevent future epidemics. Three members, Redman, Foulke and Leib, did not sign the letter. Evidence was too sketchy and they didn't want to insult Rush. Friends of Rush were quick to ridicule William Shippen who signed after spending the entire epidemic outside the city.
In the next century as the philosophy of free trade informed the effort to end restrictions on shipping, doctors who offered proofs for the local origin of contagious and potentially epidemic diseases, including yellow fever, became the darlings of liberal society. Quarantine seemed a most primitive form of commercial restriction. But Rush had expressed no interest in the principle of free trade. In 1793 the major worry of most Philadelphians was property values.
"In the name of everything good," implored an anonymous writer to Rush, "what can induce you to act so much the enemy of this place? Will it alter the nature of things, or be of the least advantage to mankind to know from whence it did arise, other than importation? Will not the New Yorkers, the Baltimoreans, and all other enemies of this town rejoice...?" Upon publication of his theory "all real property would fall in a little while 20 or more percent.... Let it not be said, we have the greatest of our enemies in our own city. Think O Think Seriously."
Samuel Meredith urged him not to publish his theory. Three friends, Bishop William White, William Lewis and Peter Baynton, thought he should publish. Tench Coxe, a Treasury official and land speculator, begged him to at least delay his pamphlet until after Congress convened. Rush had never stinted in his efforts to promote Philadelphia. He well knew as he developed his "proofs" that they did not particularly indict Philadelphia, but he wisely held fire until the city was truly back to normal, after the President moved back on November 30 and Congress convened on December 2. Rush knew how wary many politicians were, and did his might to convince them to come. On November 19 he assured the worried clerk of the House, John Beckley, that "a greater degree of health had never prevailed in this city than at present."
Congressmen came, many with trepidation. Maryland representative William Vans Murray's family was "in an uproar" at the idea of his staying in the city during the winter, and he was inclined to expect "short and irregular resurrections of the fever." But once in the city, new arrivals were quickly calmed. "It is surprising how soon a person wears off those impressions of terror, which tho' all alive when he first enters the city, are forgotten in the course of a few hours," Thomas Adams, a young lawyer and son of the vice president, wrote. "The idea of danger is dissipated in a moment when we perceive thousands walking in perfect security about their customary business."
Vice President Adams and the group of congressmen coming south with him thought it prudent to pause in Trenton to receive fresh assurances about the safety of the city, which they received. They came in and soon were partaking in the gossip that defanged the epidemic: Dr. Hutchinson was the "victim of his own French zeal," by letting in "infected persons and goods from French vessels." The "greatest mortality" was in "bad houses and among loose women and their gallants among the sailors and low foreigners." Fisher Ames, a congressman from Massachusetts, virtually closed his ears to talk about the epidemic because "many facts are lost; and faction among the doctors, and grief and terror among the citizens, have distorted those which are to be collected." As far as he could tell, the only man to have had the "decided malignant symptoms" of the disease and survive was his party's leader Alexander Hamilton. Unfortunately the method used to cure him had been "condemned by the Rushites" and never fully tested. A blanket of snow on December 4 calmed everyone.
Rush presented his proofs in a long letter to Dr. Redman, written on December 7 and published the 11th. Rush went back to basics. Yellow fever was endemic to the West Indies where, all authorities agreed, it was produced by "vegetable putrefaction." Since "the same causes (under like circumstances) must always produce the same effect," and since Philadelphia's summer had been of tropical intensity, putrefying vegetables near Water Street could have engendered a disease of tropical intensity. Instead of the typical bilious fevers, conditions produced a higher grade of bilious fever. So far all Rush had said did not have to be proved. Even though smallpox, measles, rabies and syphilis were recognized as specific diseases that could be spread in unique ways, that did not challenge the age old belief that most fevers manifested themselves according to the degree of deleterious environmental stimulus.
Undoubtedly the variability of symptoms in malarial fevers and their similarity to symptoms in dysentery, typhus, typhoid, yellow fever and dengue fever defeated any attempts to theorize that each type of fever was caused by distinct pathogens. To prove his point Rush only had to show that fevers of the same intensity as that in Philadelphia were found that sickly season in other parts of the country where ships from the West Indies didn't land and refugees from Philadelphia didn't flee. Rush's proof was in the letters he got from around the country. An old student in Caroline County, Maryland, saw fevers there more "obstinate and inflammatory" than usual, with head pains and black and yellow vomit, including a man "in a laughing delirium," who "died in about five minutes laughing to the last." A correspondent in Dover, Delaware, wrote of an epidemic of "bilious colic... unprecedented in the medical records or popular traditions of this country." A doctor in Connecticut thought 33 fevers in Wethersfield near Hartford were "analogous" to the fevers in Philadelphia.
Philadelphia's contagion was most deadly because of the greater concentration of putrefaction along the docks. The rotting coffee increased that to a level which allowed the deadly epidemic to begin, and the disease spread just as the stench of the rotting coffee was blown down streets and alleys. The annals of medicine were filled with analogous situations. Putrefied potatoes killed 14 in Tortola, West Indies, "vast quantities of cabbage thrown in a heap" killed many in Oxford, England. Rush dismissed the recently published arguments of two French doctors, Nassy and Robert, that blamed diet and greasy, dirty skin obstructing perspiration, for causing the disease. "Without the matrix of putrid vegetable matters," Rush insisted, "there can no more be a bilious, or yellow fever generated amongst us, than there can be vegetables without earth, water, or air."
Rush did not deny that in rare cases, as in 1762, an epidemic could begin from yellow fever brought to the port by a sick sailor from the West Indies. But isolated yellow fever cases were common every year in Philadelphia, produced by "active but limited miasmata." Rush argued that establishing that fact did not harm the city. "While the cause of a malignant fever is obvious to the senses, it will be easy to guard against." To deny the senses and the dictates of conscience would hazard "the lives of millions that are yet unborn." He recalled the campaign he led to cover Dock Creek which when done added much to the health of the city. Far better than exciting the fear that any ship from the West Indies could desolate the city would be to know that the city was safe as long as it was kept clean.
Meanwhile Rush battled for his theories in another arena. He used the occasion of his medical school lectures beginning the first week in December to describe his triumph over the fever and his colleagues. Over 52 years later, one of his students, Charles Caldwell, recalled Rush's first lecture as "a performance of deep and touching interest, and never... to be forgotten." Rush described the "terrible sweep" of the pestilence, his dejection at the failure of his cures, the joy of finding a successful remedy, and his persecution by the College of Physicians. Caldwell remembered that Rush had been "sufficiently sarcastic and trenchant" in ridiculing his enemies.
Along with his lectures on the "institutes," or basic principles of medicine, he lectured December 9 on "the character of Dr. Sydenham." He drew parallels between Sydenham's response to the 1665 plague and his own performance during the epidemic. Sydenham had treated patients depending on the climate, change in weather and the state of "morbid action in the system." Sydenham was accused of murdering people by blood letting and large doses of bark. He gave the fever no quarter. Rush cheered him on: "Most of his medicines are artificial, and his practice, in most diseases, is a war against nature."
Kuhn did not shrink from discussing the epidemic in his lectures, and tried in vain to deflect the applause for Rush with a brand of cynicism that usually appealed to students. He too had known the military surgeon Dr. Young, whom Rush credited with first using drastic purges. Kuhn recalled that he was "an eccentric character, and particularly so in medicine." Young was recovering from a serious illness when he insisted on taking 10 grains of calomel combined with 10 grains of rhubarb, "to carry off, according to his idea, the bile which he supposed to be the cause of the disease. The medicine however carried him off and at that time, at least, no person thought of imitating his practice." Kuhn insisted that mortality was greatest among those profusely bled and purged.
This time the fight between Rush and Kuhn did not spill out into newspapers. Even the fight over importation or local origin of the disease received little more coverage. The public controversy of the moment was the campaign to keep theaters closed. As the epidemic waned there were indications that those who had been preaching divine judgment would not be content to merely hosanna thanksgiving. On November 8, "An Earnest Call Occasioned by the AlarmingPestilential Contagion," did not mince matters: "The wrath of the Almighty seems inflamed against this city - his wrath impregnated with death!... I know there are many who attribute this awful contagion to natural causes, and ridicule the idea of a supernatural agent: but I conceive we may clearly trace the finger of God in our chastisement." The tract called for a stop to profanity, Sabbath breaking and lack of family prayers.
Most people did not respond to the lesson. When he returned to the city, Quaker James Bringhurst was appalled at how people went about their business as if nothing had happened. He began to "fear something yet more dreadful" to humiliate "this wicked proud people, many of whom look as if they scarcely thought the ground good enough for them to walk upon." On November 14 the governor set aside December 12 as a state wide day of "humiliation, thanksgiving and prayer." Such days were always problematical in Philadelphia because Quakers refused to participate in state sanctioned religious events, but they took the lead in pushing the city toward atonement. On December 2, they sent a petition to the state legislature calling for stronger laws against vice and immorality, especially the theater, which introduced "infidelity, profligacy and licentiousness." They asked the legislature to outlaw theatrical entertainments in the state. It was the only way to placate God given the "superficial impression" made on many people by "the deeply humbling dispensation lately experienced in this city."
American state governments had long passed laws for the "suppression of vice and immorality." In Delaware, theatrical entertainments were still outlawed and in October, the legislature had admonished citizens not to attend a musical entertainment "with tragical scenes" at a time when "the judgments of the Lord are manifestly surrounding us." Most regulations were crafted so they came up for periodic review before the legislature, which, Governor Mifflin noted in his December 5 address opening the legislature, was the case in Pennsylvania. The legislature flattered Quakers by letting members of the society read the petition, then it was sent to committee.
At first newspapers did not take the petition seriously beyond comparing Quakers to Spanish inquisitors. But the Quaker petition struck a chord that would resonate from pulpits on the day of thanksgiving. John Adams heard Rev. Ashbel Green, a Presbyterian, preach "judgment as well as mercy and told his hearers of all their faults. He went through the Decalogue and enumerated the transgressions of every article in it in this city." The arguments Henry Helmuth made in his soon-to-be-published memoir resounded from his and other pulpits. He recalled the throngs who went to Rickett's Circus. Then "after such a merry, sinful summer, by the just judgment of God, a most mournful autumn followed." The dying poor were brought to the vacated circus and the place once filled with "clappings of levity, was now filled with the lamentations and groans of the dying." God was trying to teach the city a lesson. All who lived through "days of death and terror" must fight to close the theaters. This was the very autumn the New Theatre, "one of the largest houses upon the continent for theatrical exhibitions," was to open, instead God caused the actors to flee the city in terror.
Part of the cogency of the argument arose because the doctors had no satisfying answers. An anti-theater "dialogue" in the newspapers used that to good effect. "A" asked "B" what the "natural or physical causes" of the epidemic were. "It is not yet ascertained, and perhaps never will be." As for the "moral" cause, it was "sin unrepented of, no doubt." The best way to prevent another epidemic was to "let the legislature enact suitable laws for the suppression of vice and immorality." On December 19, clergymen of all the major congregations sent a petition to the legislature calling for strong laws against Sabbath breaking, swearing, tippling houses, "places of gaming and lewd resort," and "theatrical exhibitions of every sort." Such reforms were imperative given "the solemn intimations of divine Providence in the late distressing calamity." They appended a 12 page pamphlet against theaters.
With the attack widened, friends of the theater had to do more than ridicule Quakers. "Plain Truth" argued that outlawing the theater would be unconstitutional, but not on first amendment grounds. Banning theaters would violate section 10 article 1 which states that a state cannot pass any "ex post factor law, or law impairing the obligation of contracts." Subscribers to the New Theater petitioned the legislature noting that the theater was built under the existing laws of the state, those building it incurred heavy debts so any law closing it "would be partial, retrospective and oppressive, and therefore unconstitutional." On February 5 the committee to which the anti-theater petitions were referred reported its recommendations for changes in the laws suppressing vice and immorality. There was no mention of theaters. The New Theater opened to acclaim, attracted crowds, and fueled a lively social season. John Adams wrote to his wife that parties were "more dissipated than last winter." The only concession to the epidemic was that many people rented rooms in the country for the coming summer so that there was "not a room to be let within 10 miles." Of the people in society, Adams thought only Mrs. Powel still seemed stricken.
The legislature did react to the epidemic. John Swanwick, a Philadelphia member, wrote a public letter to Rush asking him if he agreed that burials within the city should be outlawed to free the city from an obvious source of contagion. (It's possible this was to pressure churches, that profited from selling well located burial plots, to stop attacking the theater.) In his reply Rush gave priority to other reforms. Expanding the city limits to include Southwark and the Northern Liberties would give the corporation power to remove "offensive masses of matter which are suffered to putrefy" there. The docks and wharves should be cleaned and all "offal matters... carefully removed from gardens, yards, and cellars." During dry weather the streets should be washed with the fire engines until water could be brought in for that purpose from the soon to be completed Delaware and Schuylkill canal (a project on which work had been continuing that summer.) Trees should be planted to "absorb impure air," exhale fresh air and cool the city with shade.
By the middle of December the city's power structure was back in place and a grand jury was appointed to investigate efforts to purify the city. It reported on the 21st that there was "no cause for uneasiness or complaint." It suggested several reforms including Rush's ideas of planting trees and watering the streets. It also wanted a marine hospital south of the city to hold people in quarantine with a nearby "pest house" for victims of any future epidemic.
In the state legislature Swanwick called for special committees to draw up laws for both a board of health to supervise keeping the city clean and a harbor master to more rigorously enforce quarantines. But the legislature was slow to act. In late January the governor complained that there were reports of fevers in the West Indies yet he had no power to take preventive action as the law passed in September had expired. Even the city government seemed slow to act. For awhile many remarked on the cleanliness of the city then it became apparent that it arose from there being so little business for three months. Several newspaper correspondents complained about dirty streets and mounds of dirt left behind when they were supposedly cleaned. These worries were exacerbated by claims that the fever had returned, first in January and then just as the Committee met to give its final report in March which included a compendium of the names of those treated at Bush Hill noting those who died there and those who were "cured."
The supposed new cases did not impress the College of Physicians. It announced that there were no new cases. However, Rush was no longer a member of the college. In January Rush began seeing the symptoms of yellow fever, "particularly puking of bile, dark-colored stools, and a yellow eye." Dr. Griffitts told him of a patient with yellow skin. In February he bled John Coxe who had pneumonia and found his blood "dissolved" like the blood of yellow fever victims. Rather than raise an alarm, he merely pointed out to students that Sydenham taught that just such a similarity of symptoms in diseases succeeding an epidemic should occur. Rush however did not give any calming reports. Alarms, he thought, inspired the citizens to clean-up the city, which was all for the good. In addition he could not spare the time for controversy because he thought it essential that his memoir of the epidemic be ready before the summer when yellow fever might rage once again.
In February William Currie's account of the epidemic was published. While he endorsed blood letting and purging as the best way to treat the fever, he concluded that the fever spread through "specific contagion" like smal pox or typhus, not, as Rush insisted, through mephitic air. The fever did not spread to people outside the city because air deprived of oxygen was necessary for the spread of the contagion. But to say the stench from rotting coffee caused the disease was unwarranted. The seeds of the fever had to have come by ship from a place where the fever was endemic, the West Indies. Quarantine was the only way to protect the city from future epidemics. If the fever reached the city, then authorities should ferret out infected families, sending family member who are sick to a special hospital and family members who are sound to houses outside of town, while their house in the city was thoroughly disinfected.
Currie did not recount his activities during the epidemic, no mention of Hutchinson's death or his own illness. He wrote a medical monograph, and its influence was limited. Rush's memoir was five times the length of Currie's. With its blend of medicine and personal heroism, Rush's Account of the Bilious Remitting Yellow Fever as it Appeared in Philadelphia in the Year 1793 molded the next generation of American doctors and won a wide general audience.
He even did a better job than Carey in showing how the epidemic affected individuals. Rush discussed Hutchinson's obstinacy, Samuel Powel's dying smile, and quoted personal letters that documented Mrs. William Smith's profound depression. He detailed the terrors of the disease. Joseph Coates bled from his left eye. A patient of Dr. Woodhouse bled from her pierced ear. Dr. Fisher forgot everything that happened during his six days of fever. The disease "counterfeited nearly all the acute and chronic forms of disease to which the human body is subject." He brought order to the diversity of symptoms. It affected patients in three different ways. In some it produced coma, languor, sighing, yawning and a weak pulse; in others, pains, delirium, vomiting, heat, thirst, quick pulse with remissions in the fever; in many "the contagion acted so feebly as not to confine them to their beds or houses."
When discussing medical matters Rush did not parade his knowledge of nosology and Latin phrases, as Currie was prone to do. A master at the use of analogy, he cut medicine down to understandable size. Systems that multiplied the number of diseases were "as repugnant to truth in medicine, as polytheism is to truth in religion." Yellow fever was simply the highest grade of the fevers "derived from marsh miasmata." Noxious effluvia from rotting vegetable matter, coffee in this case, put the "seeds" of the fever in the body. In some that was enough to cause the disease within a few days. But in 99 cases out of 100, debility arising from fatigue, too much sun, or intemperance brought the fever to fruition. Even then it was possible for the disease to lay innocently in the body if several exciting causes, fear, grief, cold, sleep without proper bed clothes, or "immoderate evacuation," didn't cause it to rage. As for all the preventatives so popular during the epidemic, he thought only chewing garlic had some benefit. Rush noted in passing that "Mosquetoes (the usual attendants of a sickly autumn) were uncommonly numerous," more proof of how unhealthy the air had been because bad insects thrived in bad air.
He described why the disease's great force mocked the stimulating remedies used in treating lesser fevers with another analogy. Yellow fever was "like a tedious equinoctial gale acting upon a ship at sea; its destructive force was only to be opposed by handing every sail, and leaving the system to float, as it were under bare poles." Hence the need for depleting remedies like purging and bleeding. Given the force of the disease his remedies were not drastic at all. They created "an artificial weak part in the bowels," and diverted "the force of the fever to them." That "saved the liver and brain from fatal or dangerous congestions." All criticisms leveled at mercury during the epidemic were unfounded. "Hundreds who took it declared they had never taken so mild a purge." Children took wrong doses with no ill affect. The salivation it caused was not inconvenient, especially when it's considered that it was a harbinger of a cure. Only one patient who achieved it subsequently died. Indeed toward the end of the epidemic his assistants rubbed mercury on the gums of patients to hasten salivation. Two people lost teeth, but those teeth had already been loose and decayed.
As for his bleeding being too copious he did not "lose a single patient whom I bled seven times or more." Rather than weakening patients, copious bleedings invigorated many, and in some cases cured chronic ailments too. Rush estimated that his methods saved the lives of 6,000 people. Yet God did more than provide a remedy for one fever. He provided a system so successful that medicine in the future would "consist more in a new application of established principles, and in new modes of exhibiting old medicines, than in the discovery of new theories, or of new articles of the materia medica."
After heralding a new era in therapeutics, Rush urged radical reforms in how medical care was provided. Bush Hill had complete provisions and country air, still 448 out of 807 patients died. In the next epidemic, people had to prescribe for themselves. "At the expense of an immense load of obloquy, I have addressed my publications to the people. The appeal though hazardous, in the present state of general knowledge in medicine, has succeeded.... (T)he pride and formalities of medicine, as far as they relate to this disease, are now completely discarded in our city, as the deceptions of witchcraft were, above a century ago." It only remained to increase the general knowledge of medicine. "The time must and will come, when... the general use of calomel, jalap, and the lancet, shall be considered among the most essential articles of the knowledge and rights of man.... All the knowledge that is necessary to discover when blood letting is proper, might be taught to a boy or girl of twelve years old in a few hours." As soon as yellow fever makes its appearance, a description of all symptoms which are the precursors to the disease should be published and people directed to purge and bleed immediately upon the onset of symptoms.
In the decade prior to the Philadelphia epidemic many observers had noted the increase in the incidence of fevers throughout America. Rush himself had written an essay on the problem in 1786 in which he blamed the increase in the number of mill ponds unprotected by purifying trees. With typical optimism Rush, and his student Currie, for that matter, documented this phenomena, and in the next breath, discounted its significance. Fevers would end once farmers became settled or noxious urban creeks were covered. Now the onslaught of such a deadly epidemic in the most civilized square mile in the new country forced a rethinking. Rush made Philadelphia's particular crisis, a passage for all Americans. The deadly fever was but the worst form of the common, nagging, debilitating fevers that chilled and shook all the milk and honey tomorrows, the promise of America. In conquering yellow fever he found the key to conquering the endemic discomforts that confronted all Europeans in the new land. And as was only proper in a universe created and continued through divine inspiration, there was a moral lesson in his discovery. The land dealer's paradigm of plenty, the pursuit of happiness through engorgement, had to give way to denial, depletion, and enforced starvation to the point of letting the stuff of life drain out of the body. Here was the Spirit of '76 that encouraged self-denial applied to the hazards that every change in season brought. Prevention depended on communal discipline directed toward scrupulous cleanliness and morality.
Rush's ideas served God. He looked down upon the recommendations of colleagues like Currie. In retrospect Currie was a better epidemiologist. He soon published a 15 page critique of Rush's book which detailed circumstantial evidence showing how the fever was rife in the West Indies, that people who had the fever boarded ships for Philadelphia, that passengers on ships from the islands were sick upon arriving in Philadelphia, and that the sick had been in Mrs.LeMaigre's kitchen and other boarding houses. The Englishman treated by Physick in early August had just come from a West Indian island. Currie also ridiculed Rush's contention that yellow fever was a higher grade of bilious fever. The former was contagious and affected the body differently. However Currie did not battle solely with the weapons of science. He may not have bent his arguments to glorify God, but he did glorify the city. His "Impartial Review of Rush and the Wholesomeness of the City Vindicated" concluded by pointing out that, judging from the bills of mortality, Philadelphia was the most healthy city in the world except during those rare years, 1762 and 1793, when yellow fever was imported into the city.
The next sickly season was fast approaching and more after that. Baltimore and New Haven had yellow fever epidemics in 1794, New York in 1795, Philadelphia in 1797, and all major ports from Baltimore to Boston in 1798. They tested the country as well as Rush's theories and practices. For a short history of scope of the epidemics in the 1790s go to A Short History of Yellow Fever
Tuesday, March 24, 2020
11. With the door open between us
"Unless Providence sends a heavy rain or a very great change in you atmosphere in point of cold and moisture," Dr. Rodgers wrote to Rush, "I see nothing but absolute destruction for your deserted city." Worse still was if the cold came and did not stop the epidemic. That would be proof that the fever was actually the plague and might last through the winter. On Sunday the 13th, Attorney General Edmund Randolph, who was in nearby Germantown, wrote to the president that he had heard that Rush had seen "gland swellings and other symptoms of plague." That morning Randolph heard Dr. William Shippen, who rode out the epidemic in the suburbs, say that "the malady had scarcely any resemblance of the yellow fever,"and had a "strong likeness" to the plague. A letter from Philadelphia in a Baltimore paper claimed that "the fatality has been as great in proportion as that of the plague in London during the time of Sydenham." A Baltimore newspaper also reported that it had been decided to burn down the infected part of Philadelphia.
Speaker of the US House of Representatives, John Trumbull of Connecticut, worried that the city would still be unsafe when Congress was scheduled to convene in December. From Mount Vernon Washington quizzed his advisors on his power to convene Congress in another place. He asked Pickering and Wolcott if Germantown was safe and if all the terrible things he had heard were true, that many "of our acquaintances have fallen victims...; that near 4000 have died, and that the disorder rages more violently than ever." His advisors split on whether he had the power to convene Congress elsewhere. Jefferson and Madison worried that removal might jeopardize the compromise that moved Congress from New York to Philadelphia in 1790 and would move it to the banks of the Potomac River in 1800.
As for the state of the city, Pickering had been going every day to Walnut Street to encourage the bedridden Rush, an act of courage given that no less an authority than Rush was certain that his house was the most infected place in the city. Pickering noticed that unlike the week before, Rush's house was no longer "thronged with applicants for assistance." Rush's three apprentices, Coxe and Fisher had been joined by an old student James Woodhouse, continued giving out medicines and making visits for Rush. They agreed that on the 12th and 13th the number of applicants had "sensibly lessened." Pickering dashed off a note to the president with the encouraging news. And Germantown had to be safe. Governor Mifflin was still there.
That fewer were sick was scant comfort to those already sick. Margaret Morris had the bitter gratification of seeing proof of her diagnostic skill. Benjamin Smith did have the fever, badly. On the 15th she left Smith with what she thought were favorable symptoms. He and Debby had been "twice bled" and both seemed comfortable. Not all the amateur doctors were as pleased. The "grand lavage" gave Seguin no relief. Girard had Deveze come look at the patient. The doctor thought the case hopeless but applied a plaster which seemed to help. Up with Seguin until 4 a.m., Girard at least had a chance to catch up with some business correspondence. He could only write that he had no time for his "customary exactness," indeed no time at all for business given the panic and desolation in the city. "I do not know when we shall see the end of it," the weary man, feeling none too well himself, complained. Then Seguin fell "into a profound state of collapse." Girard was oblivious to a change outside, cold rain. At dawn on the 16th with the thermometer read 37 degrees, Seguin died.
"For some days past," the Federal Gazette announced on the 16th, "the malignant fever has very considerably abated. But since yesterday's fall of rain, so visible an alteration has come within our observation, that we feel it a pleasing duty to calm the anxiety of our friends." John Welsh talked to a man at the Pine Street burying grounds and learned that only one body had been buried the day before and none were expected that day. Welsh himself saw "an amazing change... in this city for the better, and it is generally believed that ten days will perfectly eradicate the contagion,and make returning safe and eligible."
The man who first recognized the epidemic and the terror it would bring was in no position to herald its imminent demise and signal its end. On the 15th Rush was only strong enough to sit up in bed and pray for rain. He wrote to Julia: "All hearts now are faint, and all hope is now in God alone." Rush's letter of the 16th to Julia is missing. In his notebook he jotted down "Rain. Blessed, Blessed be God for it." On the evening of the 17th he wrote to Julia that while "the disease evidently declines,... many have died this day, and many are yet very ill." He listed seven dead and noted that Rev. Dr. Sproat was seriously ill. "None of the above persons were my patients," he added. He did feel some regret at the death of a bleeder he had convinced to stay in the city.
When he continued the letter in the morning, he showed that his paranoia had fully recovered: "No one physician except Dr. Griffitts and Dr. Annan has sent to inquire after my health since my last confinement. The confederacy now is stronger than ever against me.... Many, many persons I fear are killed now by bark, wine, and laudanum to spite me. Their rancor has no bounds. They watch my patients with great solicitude, and console themselves under my numerous cures by declaring that my patients had nothing but the common fall fever. The few whom I lose they say died of the yellow fever and are all killed by mercury and bleeding." In his notebook he recorded the report that Dr. Benjamin Duffield had accused him of killing 99 out of 100 patients and said he "ought to have a mad shirt put on."
It was up to the Committee to officially declare the city safe. Yet its members scarcely had the time to debate the matter much less investigate all the pockets of possible contagion in the city. As the rumor spread that the city was safe, the poor swallowed their fear, came out of their hovels and tenements and came to the Committee for food and, as it was getting cold, firewood. A split developed in the Committee. Secretary Caleb Lownes wrote in the minutes that the sickness was "more general and alarming than at any time." He recorded an affecting story: a carter heard a cry and upon going to the house it came from, he found the father dead, "two children near him also dead, the mother in labor." She and the new born soon died. And that week another Committee member died, the fourth.
Mayor Clarkson led the optimists. True, upwards of ten a day were still being sent to the hospital, but most of them were from Southwark. On the 17th he took the occasion of a thank you letter to New York for its donation of $5,000 to report that light rain and cool weather "appear to have given a check" to the disorder as shown by a decrease in funerals and applications to the hospital. A few days later he noted that the "general appearance" of the city was "pleasing;" physicians less busy; more people recovered than before; there was "an obvious difference" in the looks of those who remained, a new "cheerfulness;" several shops had reopened.
To settle any argument the Committee decided to get an exact count of burials from all the graveyards. The numbers did show a decrease from a peak in deaths of 119 on October 11 to 65 on the 19th. Pickering held up a letter to the president so that he could get the official tally. But from the 11th to the 19th, 700 had been buried. Pickering told the president that he was taken aback by the number, but he continued to insist that things were much better. Rush had told him that the disorder had abated by "at least one half," and that the city would be "free of the contagion" by December. Rush's apprentices had heard that there were only three dangerous cases at the hospital.
When Rev. Sproat died, his followers decided to honor him with a traditional burial as best they could. The feeble old man, who had followed both his daughter and son to the grave alone, would not go to his alone. But the mourners were cautious. The old preacher's black admirers, about 30 strong, walked behind the coffin. Seventy whites, mostly women, followedbehind them. The graveyard keeper was astounded by the crowd. The show of bravery did not diminish fear because Rev. Joseph Turner, who preached at the grave, became ill the day after.
The Quaker lawyer John Todd found no peace in the countryside as he kept outdoors away from his family even on the coldest mornings trying to purify himself. On the 17th he was sure he had the fever. He left his wife Dolley again and went to his brother James's house in the city and died. Dolley lost her baby the same day. She was destitute and wrote to her brother-in-law for help. He sent her nothing except the rug that was in the room where her husband died. It was infected and of no use to him. It was not until after she married a Virginia lawyer, congressman James Madison, two years later that Dolley won her share of the Todd estate.
Benjamin Smith died on the afternoon of the 18th, "without a sigh or groan - and perfectly sensible." After the favorable signs on the 15th he had steadily declined. Debby Smith completely collapsed. As Margaret Morris prepared Benjamin for the grave, she had to go to her daughter and try to rally her. Just as death had led to the evacuation of the Pear Street house, so death led to the evacuation of the Front Street house. In the week that followed Debby moaned continually. Margaret had lost her husband when she was 29, but she had been surrounded by friends. She and Debby were surrounded by young children, servants and sick or incapacitated relatives. Margaret could do nothing to console her daughter. As for herself, she found comfort in a Bible prophecy "which seems fulfilling" - Amos 3:8 "...there shall be many dead bodies, in every place they shall cast them forth with silence." "When I look round," she continued in a letter she wrote the 24th, "and see what havoc death has made in our city - the young and vigorous taken away, the old and helpless left, many of them without support - my spirit almost dies within me and I am ready to say 'what wait I for? - my delight is in Thee.'" But 15 people were in her house and she very much the strongest.
A few doors down Walnut Street Rush longed to see his family. In his notebook he listed reasons why he didn't leave the city: he hoped to remain useful; he thought the contagion within him would remain dormant as long as he stayed in his house; if he left, any exciting cause in the next 16 days could cause a return of the fever; there was no medical aid in the country; his mother was not strong enough to leave; and he had no place where he could go without risking infecting those who took him in. He had no compunction about receiving callers in his house. Several came with gifts of fruit. Margaret Morris called and shared her experiences and thanked him for his guiding principles. Rush noticed that patients were "more affectionate - more ardent" in their gratitude.
He sent Marcus out to see how the baby Benjamin Rush fared - "cheeks like a rose," he told Julia. On the morning of the 21st the cold prompted him to praise God for deliverance. If the cold increased and heavy rain followed "the disease will be driven from the city in a few weeks." He took a ride in the city that day, his first outing since the 10th. He "found more people in the streets than before..., and their countenances wore a more cheerful aspect." He assured his wife that if November was as cold as usual, they would be together again by the middle of that month. Then on Tuesday the 22nd the temperature climbed to 65. On the 23rd Rush wrote to Julia that the epidemic had "revived," and mortality was "nearly as great as before the late rain and cold weather."
Pickering came by that day, sharing more of the death count from Clarkson - 3,400 dead since August 1. In A Journal of the Plague Year Daniel Defoe's narrator met his doctor friend just as the 1665 epidemic reached its peak and was easily convinced by the doctor, who cited statistics, that the force of the disease was spent. The narrator also noted how emboldened people became once they sensed the epidemic's end. Many still died but the conviction grew that if one got the disease, it would be more easily cured. Of course Defoe had written his "eyewitness" account 57 years after the epidemic. Surrounded by death, Rush looked to god, not to statistics. "O! that God would hear the cries and groans of the many hundred and perhaps thousand sick which still ascend to his throne every hour of the day and night from our desolating city!"
Others began giving the all clear. For the first time since September 11, less than 40 were buried. The Gazette knew of no one sick. A correspondent asked if it was not time for the rest of the country to reopen communication with the city. On the 25th the Gazette reported that stores were opening, families returning, the wharves "once more enlivened," as a London ship came up to unload. On Saturday the 26th the market was almost back to normal, "with every species of vegetable product - fowls, butter, &c. &c." The Committee still thought people outside the city should wait another week or 10 days before coming back in. It also published directions for cleaning houses that had been closed up. They should be aired out for several days with all windows and doors open. "Burning of nitre will correct the corrupt air which they may contain. Quick lime should be thrown into the privies and the chambers whitewashed."
John Welsh reported that it was dangerous to walk on the streets "so common is washing windows." The high on the 28th was 37 degrees. John Mease cheered the "cold wind, which... leaves no longer room to hesitate about return of the inhabitants, and is corroborated by the new faces we begin to meet in the streets." Better still his son James, the doctor, was "in a good way, crying hunger all day long." On the 31st a white flag was hoisted over Bush Hill with the legend "No More Sick Persons Here."
On November 2 a list of 7 reasons why God visited an epidemic on the city signed by Jeremiah was published by the Federal Gazette. In his letters to his wife Rush did not allude to or even hint at writing it, but Jeremiah was his favorite prophet and the first two reasons were Rush's particular peeves: lust for wealth "excited by our systems of paper credit," and "rack rents." The first reason condemned his nemesis Alexander Hamilton. And Rush was mad because his rent had just been raised. The five other reasons were more traditional: attending the circus and theater, breaking the Sabbath, swearing, neglect of religious instruction in schools and pride in luxuries.
Rush couldn't shake off gloom and doom. "Many, I fear, will die with [the fever] in the course of the next month from ignorance or carelessness," Rush wrote to his wife on the last day of October. "The citizens are crowding into town every day. I wish they may not repent their coming in so soon." Rush proved to be a prophet. The white flag had to be struck. On November 2 a silversmith named Brooks who had been in the city a week died of the fever. Margaret Morris warned relatives that there was "still the seeds of the contagion lurking in our city and in the corners of many houses which have been shut up as soon as the family have died.... Depend upon it we shall hear of the fever beginning to rage again." The return of muggy weather did not help.
Joseph Dawson dreaded the consequences of that and confessed "for my own part I feel more debilitated than at any period for these six weeks past." In a published notice Rush did not forbid return but recommended that houses be aired out 3 to 4 days and nights, and that returnees avoid "cold, fatigue and intemperance." On the 4th the Committee could "not say that it was totally eradicated."
Impatient at the equivocation in the city Governor Mifflin in Germantown prompted his port physicians James Mease (said to be "a walking skeleton") and Samuel Duffield to declare that the disease had "rapidly declined" and would be gone in two weeks, so Congress could meet as scheduled. Within three days Mifflin returned himself only to be confronted with reports that a ship from St. Domingo with passengers sick with yellow fever was below the city. He sent Samuel Duffield and Deveze to investigate and they found very few sick but many wounded soldiers from recent fighting on the island. To avoid any panic Mifflin ordered the ship to stay at quarantine.
One bureaucrat's wife told her husband that he "must not think of going" into the city. Rumors became so virulent that they even gave John Welsh pause. He knew of one dead, he wrote to his boss, and "several others who had come in are sick, and some every day are going off with death. The disease is very unaccountable, and our men of the deepest knowledge, know but little of it." On the 6th a committee of New York merchants recommended the continuation of the quarantine. Fearing that merchants would buy infected clothes cheaply in Philadelphia and sell them in New York, the health committee there decreed that all goods brought in from Philadelphia had to be unpacked and exposed to "open air" for 48 hours. Clothing, linen or bedding had to be "washed in several waters," then smoked "with the fumes of brimstone for one day."
But people still returned to the city. On the 7th Margaret Morris marveled at the streets "full of people and waggons loaded with furniture." She still warned her family not to come, but on 9th to her joy and surprise, her remaining son and Benjamin Smith's partner, Samuel Emlen, came in for a tearful reunion. President Washington made a day trip to the city on the 11th, despite Attorney General Randolph warning that "we have not yet learned, that any radical precautions have commenced for purging the houses and furniture." One returnee found the city "beautifully clean, nothing lying on the streets or gutters." On the 13th stages north and south were running. John Welsh reported that the streets were "in an uproar and rendered the wharves impossible by reason of the vast quantities of wine, sugar, rum, coffee, cotton & c. The porters are quite savvy and demand extravagantly for anything they do." On the 14th the Committee announced that while houses still had to be purified and infected clothing and bedding "washed, baked, buried or destroyed," anyone could come to the city "without danger from the late prevailing disorder."
Still convalescing, Rush spent most of his time reading, principally Sydenham, and working on his notes about the epidemic. As a visiting physician at the Pennsylvania hospital his rotation for visiting patients was slated to begin on November 2, and he flattered himself that he would be able. He wasn't, which caused no problems. The other staff physicians came to him to discuss the case of a patient who needed an amputation. His good friend Samuel Coates was president of the hospital and dropped by frequently with news of the reviving city. Coates saw the state Rush was in, and loaned him 50 pounds. Rush's major preoccupation continued to be his colleagues. He recoiled at letters from people in the countryside, including Julia, that suggested he was being hailed as a hero in the city. "This is far from being true," he wrote to Julia on October 24. "The relations and patients of the physicians whose practice I have opposed have taken part with them in their resentments, and I am now publicly accused at every corner of having murdered the greatest part of the citizens who have died of the present disorder." He longed to end his days teaching in New York. In Philadelphia, he saw nothing "but strife and misery."
This bitterness became like a refrain in all his letters. He heard rumors that patients of his enemies were surreptitiously saved by the new remedies. "Dr. Wistar's brother has been recovered..., by three bleedings in one day and by a strong dose of the mercurial medicine." French doctors "destroyed at least two-thirds of all who have perished by the disorder.... One of them (a Jew) does not even feel the pulse of his patients. Upon being offered a hand for that purpose by a Mr. Morrison, he said, 'No - no. I never feel the pulse - that is the way the Philadelphia physicians catch the disorder.' This man died on the 3rd day." He blamed John Todd, Jr.'s, death on a French doctor.
During late October and early November, there were no published attacks against Rush. He heard that Currie had written to Hodge attacking Rush's behavior during the epidemic, claiming that he had personally profited from the sale of calomel and jalap. To his wife Rush denied taking a dime for medicine. He had sent patients who could pay to the apothecaries so he could save his supply for the poor. As much as the letter upset him, he was eager to get and publish a copy. "It will show that I had a more formidable monster than the disease to contend with during the late calamity."
He heard from a young colleague, Dr. Michael Leib, that Dr. Barton had intended to try to expel Rush from the College of Physicians unless his friends will plead in his behalf that he was "insane." Rush had already resolved to quit the college. On November 5 he sent a one sentence resignation, and a copy of the Works of Sydenham. Less the symbolism of that be lost on the public, he saw that the weekly Gazetteer printed an "extract of a letter from Philadelphia," that explained that Sydenham had written the Bible of medicine. If the members of the college had been better acquainted with it, the death toll from the epidemic "would not have so greatly swelled."
Some colleagues pleaded for him to remain in the college, and Julia's letters tried to sooth him with praise for his works from the Governor on down. She advised him not to get so upset at colleagues who had not earned the credit he had. He promised to "attend" to her advice, then wailed "Indeed I never intended to begin a controversy with them. I have hitherto calmly contradicted their falsehoods. Dr. Hodge (stimulated by the Wistar family) leads the van of my calumniators. I gave him no other offense than declining to consult with him...." To do so would have been like "a Jew and a Christian attempting to worship in the same temple.... I did not take this decisive step with my brethren till I made myself hoarse in trying to persuade them to adopt the new remedies, and until they had accused me in the newspapers of murdering my patients by bloodletting. The die with them is cast. I feel as if I were more than able through divine support to meet the gathering storm." He did admit that since more people had come to town, he had heard enough encouragement so that he was satisfied that he would "not be driven from the city." He was sent for by one of Kuhn's wealthiest patients.
Well served by his connections in the press, articles favorable to Rush and his methods lampooned his opponents. Benjamin Duffield who worked at Bush Hill was reportedly duped by four prison inmates into thinking they had the fever. He had them sent to the hospital where they robbed some nurses and escaped. An article told the tale of "the foul-mouthed Ben," who approached patients with "an over-dose of New England drinkabus" as a preventative. He asked no questions and thought the state of the pulse "of no consequence in the yellow fever." Shortly after that appeared a lampoon of "Dr. K___", who "never smiled in his life, except at the rise of stock," and a disciple who killed six patients with, respectively, chamomile tea, gin, laudanum, beef broth and "cayan pepper," bark, and killed the last by refusing to bleed despite the patient's begging to be bled.
Meanwhile, as the epidemic wound down, not a few of Rush's patients died. He had an explanation for each one. George Bullock had concealed his illness. Then after Woodhouse had stabilized him, Bullock was poorly attended by an ignorant nurse. Rush's cousin Parry Hall died because after sitting up three nights with his dying sister-in-law nothing could have cured him. Rev. Dr. William Smith's 70 year old wife died because she was so depressed at the death of friends that she was beyond the power of bleeding and purging.
Even with the epidemic ending Rush saw to it that testimonials from those cured by his remedies were published. Dr. Griffitts had been bled seven times in four days, and complained "what shall we say to the physicians who bleed but once." The bookseller William Young wrote that the bark failed when 10 in his family were sick. Rush was too indisposed to attend, but they followed his printed directions and all recovered. The leaders of the African American nurses Jones and Allen visited Rush and told him how they filled in for doctors and "recovered between two and three hundred people" by following Rush's directions. Very likely at Rush's suggestion, Jones and Allen reported their success with Rush's remedies in a letter to the Federal Gazette.
As the epidemic ended, Rush's remedies were not what worried his fellow citizens. Many were alarmed that his theory on the origins of the fever would cripple the city's economy. Richard Peters, a federal judge then in the countryside, had a townhouse a few doors down from Rush. He well knew the passion and persistence his neighbor brought to any controversy. On October 23 he warned Pickering that Rush's "assertion that the Philadelphia hot beds produced this deadly plant is I believe unfounded and I am sure very mischievous," and would be "eagerly caught at by the anti-Philadelphians." The book publisher Mathew Carey wrote a brief history of the epidemic on October 16 that was in a newspaper a few days later. He dismissed Rush's theory on the epidemic's origin, noting that "several other gentlemen of the faculty believe that it has been brought from the West-Indies, which is the most probable opinion." The stock broker Matthew McConnell wrote a friendly but blunt letter to Rush reminding him that his theory was "a dangerous one to advance if not true considering the consequences that might result there from to the city as the seat of the government."
Rush replied that "the good opinion of the citizens of Philadelphia was now of little consequence to me." Rush lumped opponents of local origin with those who attacked purging and bleeding. McConnell assured him that he had "numerous" friends. "In the company I was in,... you were spoken of respectfully and no suggestions thrown out against your practice." He begged Rush to stand his ground. The doctors who had deserted the city had lost their reputations.
Rush must have smiled at the naivete of the layman. The cause, nature and cure of the disease were all linked. His readings of Sydenham and others, whose theories were influenced by the Great Plague, helped him understand how the Philadelphia epidemic could be used to elucidate the nature of all fevers. With the help of old students working in other cities, he was able to see through the claims of rival cities that only Philadelphia had the fever. He had been getting letters from around the country describing dangerous fevers in places unvisited by ships from West Indies or refugees from Philadelphia.
Obviously the fevers arose from local conditions replicated in several places that summer. From his vantage at the eye of the storm, he was able to perceive a sea change in the nature of disease in America. The epidemic's end did not allow him to forgive opponents, writing off their obstinacy as arising from the emotions of a terrible moment that visited the city every 30 years. Their continued obstinacy and persecutions of him stood in the way of his putting an American stamp on medical theory and practice and saving the whole country from the advent of a deadlier grade of fevers. Rush told his wife he was waiting for permission to use the names of his correspondents. Then he would publish his proof of the local origin of the disease, and after that an extensive memoir that would make the epidemic the stuff of medical history.
Julia was waiting for her husband to come and get her. Appealing to his chivalry she had suggested that in honor of her sacrifices she deserved to be escorted into the city by him. Physically he was still tentative. He told her that nothing would please him more than riding out to Princeton to get her. On Sunday the 3rd he went as far as the farm where baby Ben was staying. "My emotions upon his being brought near me (for I did not get out of the [carriage] chair,) may more easily be conceived then described." He took the precaution of only meeting people in the fresh air for fear of spreading infection, and would not let any one in the countryside some within 5 or 6 feet.
He decided he did not want his family to return to an infected house. So he began looking for a new house to rent. In case he was unable to get one soon enough, Marcus got to work "preparing and purifying the house." All the furniture was placed in the yard over night. Rush worried that "no frost has touched them." On November 8 he decided that all contagion had been discharged from his body. His pupils contracted "to its natural fire" and he began having regular bowel movements. But after a trip in the countryside on the 12th he felt "somewhat indisposed" and returned home to take calomel.
Julia realized she was not going to get an escort to the city. So she came to the farm where baby Ben was and sent word to her husband. She missed getting the letter he wrote to Princeton on the 11th worrying that four people had died of yellow fever that Sunday, one "from the contagion lodged in a surtout coat which her son brought into the house." But upon hearing that she was at the farm, Rush relented. He couldn't go out to see her, he explained, because he had a patient "with a disorder which cannot bear the loss of two visits a day at a certain hour without risk of his life." And he feared the ride out and "first interview" with her would be too exhausting. So he sent Fisher out to bring her in, if she wished. "If you come to town, you shall have the front room (now the purest in the house) to yourself. I will sleep in the room adjoining you with the door open between us."
On the 13th she arrived. "My wife wept," Rush wrote in his notebook "and was unable to speak for near a minute. She spent the day and night with me and returned the next day to Princeton." Their daughters were still there, and she was uncomfortable in the infected house. Rush promptly rented another. On November 22, exactly three months after the celebration for the African Church, the entire Rush family was together once again. The epidemic was over.
Go to chapter 12
Speaker of the US House of Representatives, John Trumbull of Connecticut, worried that the city would still be unsafe when Congress was scheduled to convene in December. From Mount Vernon Washington quizzed his advisors on his power to convene Congress in another place. He asked Pickering and Wolcott if Germantown was safe and if all the terrible things he had heard were true, that many "of our acquaintances have fallen victims...; that near 4000 have died, and that the disorder rages more violently than ever." His advisors split on whether he had the power to convene Congress elsewhere. Jefferson and Madison worried that removal might jeopardize the compromise that moved Congress from New York to Philadelphia in 1790 and would move it to the banks of the Potomac River in 1800.
As for the state of the city, Pickering had been going every day to Walnut Street to encourage the bedridden Rush, an act of courage given that no less an authority than Rush was certain that his house was the most infected place in the city. Pickering noticed that unlike the week before, Rush's house was no longer "thronged with applicants for assistance." Rush's three apprentices, Coxe and Fisher had been joined by an old student James Woodhouse, continued giving out medicines and making visits for Rush. They agreed that on the 12th and 13th the number of applicants had "sensibly lessened." Pickering dashed off a note to the president with the encouraging news. And Germantown had to be safe. Governor Mifflin was still there.
That fewer were sick was scant comfort to those already sick. Margaret Morris had the bitter gratification of seeing proof of her diagnostic skill. Benjamin Smith did have the fever, badly. On the 15th she left Smith with what she thought were favorable symptoms. He and Debby had been "twice bled" and both seemed comfortable. Not all the amateur doctors were as pleased. The "grand lavage" gave Seguin no relief. Girard had Deveze come look at the patient. The doctor thought the case hopeless but applied a plaster which seemed to help. Up with Seguin until 4 a.m., Girard at least had a chance to catch up with some business correspondence. He could only write that he had no time for his "customary exactness," indeed no time at all for business given the panic and desolation in the city. "I do not know when we shall see the end of it," the weary man, feeling none too well himself, complained. Then Seguin fell "into a profound state of collapse." Girard was oblivious to a change outside, cold rain. At dawn on the 16th with the thermometer read 37 degrees, Seguin died.
"For some days past," the Federal Gazette announced on the 16th, "the malignant fever has very considerably abated. But since yesterday's fall of rain, so visible an alteration has come within our observation, that we feel it a pleasing duty to calm the anxiety of our friends." John Welsh talked to a man at the Pine Street burying grounds and learned that only one body had been buried the day before and none were expected that day. Welsh himself saw "an amazing change... in this city for the better, and it is generally believed that ten days will perfectly eradicate the contagion,and make returning safe and eligible."
The man who first recognized the epidemic and the terror it would bring was in no position to herald its imminent demise and signal its end. On the 15th Rush was only strong enough to sit up in bed and pray for rain. He wrote to Julia: "All hearts now are faint, and all hope is now in God alone." Rush's letter of the 16th to Julia is missing. In his notebook he jotted down "Rain. Blessed, Blessed be God for it." On the evening of the 17th he wrote to Julia that while "the disease evidently declines,... many have died this day, and many are yet very ill." He listed seven dead and noted that Rev. Dr. Sproat was seriously ill. "None of the above persons were my patients," he added. He did feel some regret at the death of a bleeder he had convinced to stay in the city.
When he continued the letter in the morning, he showed that his paranoia had fully recovered: "No one physician except Dr. Griffitts and Dr. Annan has sent to inquire after my health since my last confinement. The confederacy now is stronger than ever against me.... Many, many persons I fear are killed now by bark, wine, and laudanum to spite me. Their rancor has no bounds. They watch my patients with great solicitude, and console themselves under my numerous cures by declaring that my patients had nothing but the common fall fever. The few whom I lose they say died of the yellow fever and are all killed by mercury and bleeding." In his notebook he recorded the report that Dr. Benjamin Duffield had accused him of killing 99 out of 100 patients and said he "ought to have a mad shirt put on."
It was up to the Committee to officially declare the city safe. Yet its members scarcely had the time to debate the matter much less investigate all the pockets of possible contagion in the city. As the rumor spread that the city was safe, the poor swallowed their fear, came out of their hovels and tenements and came to the Committee for food and, as it was getting cold, firewood. A split developed in the Committee. Secretary Caleb Lownes wrote in the minutes that the sickness was "more general and alarming than at any time." He recorded an affecting story: a carter heard a cry and upon going to the house it came from, he found the father dead, "two children near him also dead, the mother in labor." She and the new born soon died. And that week another Committee member died, the fourth.
Mayor Clarkson led the optimists. True, upwards of ten a day were still being sent to the hospital, but most of them were from Southwark. On the 17th he took the occasion of a thank you letter to New York for its donation of $5,000 to report that light rain and cool weather "appear to have given a check" to the disorder as shown by a decrease in funerals and applications to the hospital. A few days later he noted that the "general appearance" of the city was "pleasing;" physicians less busy; more people recovered than before; there was "an obvious difference" in the looks of those who remained, a new "cheerfulness;" several shops had reopened.
To settle any argument the Committee decided to get an exact count of burials from all the graveyards. The numbers did show a decrease from a peak in deaths of 119 on October 11 to 65 on the 19th. Pickering held up a letter to the president so that he could get the official tally. But from the 11th to the 19th, 700 had been buried. Pickering told the president that he was taken aback by the number, but he continued to insist that things were much better. Rush had told him that the disorder had abated by "at least one half," and that the city would be "free of the contagion" by December. Rush's apprentices had heard that there were only three dangerous cases at the hospital.
When Rev. Sproat died, his followers decided to honor him with a traditional burial as best they could. The feeble old man, who had followed both his daughter and son to the grave alone, would not go to his alone. But the mourners were cautious. The old preacher's black admirers, about 30 strong, walked behind the coffin. Seventy whites, mostly women, followedbehind them. The graveyard keeper was astounded by the crowd. The show of bravery did not diminish fear because Rev. Joseph Turner, who preached at the grave, became ill the day after.
The Quaker lawyer John Todd found no peace in the countryside as he kept outdoors away from his family even on the coldest mornings trying to purify himself. On the 17th he was sure he had the fever. He left his wife Dolley again and went to his brother James's house in the city and died. Dolley lost her baby the same day. She was destitute and wrote to her brother-in-law for help. He sent her nothing except the rug that was in the room where her husband died. It was infected and of no use to him. It was not until after she married a Virginia lawyer, congressman James Madison, two years later that Dolley won her share of the Todd estate.
Benjamin Smith died on the afternoon of the 18th, "without a sigh or groan - and perfectly sensible." After the favorable signs on the 15th he had steadily declined. Debby Smith completely collapsed. As Margaret Morris prepared Benjamin for the grave, she had to go to her daughter and try to rally her. Just as death had led to the evacuation of the Pear Street house, so death led to the evacuation of the Front Street house. In the week that followed Debby moaned continually. Margaret had lost her husband when she was 29, but she had been surrounded by friends. She and Debby were surrounded by young children, servants and sick or incapacitated relatives. Margaret could do nothing to console her daughter. As for herself, she found comfort in a Bible prophecy "which seems fulfilling" - Amos 3:8 "...there shall be many dead bodies, in every place they shall cast them forth with silence." "When I look round," she continued in a letter she wrote the 24th, "and see what havoc death has made in our city - the young and vigorous taken away, the old and helpless left, many of them without support - my spirit almost dies within me and I am ready to say 'what wait I for? - my delight is in Thee.'" But 15 people were in her house and she very much the strongest.
A few doors down Walnut Street Rush longed to see his family. In his notebook he listed reasons why he didn't leave the city: he hoped to remain useful; he thought the contagion within him would remain dormant as long as he stayed in his house; if he left, any exciting cause in the next 16 days could cause a return of the fever; there was no medical aid in the country; his mother was not strong enough to leave; and he had no place where he could go without risking infecting those who took him in. He had no compunction about receiving callers in his house. Several came with gifts of fruit. Margaret Morris called and shared her experiences and thanked him for his guiding principles. Rush noticed that patients were "more affectionate - more ardent" in their gratitude.
He sent Marcus out to see how the baby Benjamin Rush fared - "cheeks like a rose," he told Julia. On the morning of the 21st the cold prompted him to praise God for deliverance. If the cold increased and heavy rain followed "the disease will be driven from the city in a few weeks." He took a ride in the city that day, his first outing since the 10th. He "found more people in the streets than before..., and their countenances wore a more cheerful aspect." He assured his wife that if November was as cold as usual, they would be together again by the middle of that month. Then on Tuesday the 22nd the temperature climbed to 65. On the 23rd Rush wrote to Julia that the epidemic had "revived," and mortality was "nearly as great as before the late rain and cold weather."
Pickering came by that day, sharing more of the death count from Clarkson - 3,400 dead since August 1. In A Journal of the Plague Year Daniel Defoe's narrator met his doctor friend just as the 1665 epidemic reached its peak and was easily convinced by the doctor, who cited statistics, that the force of the disease was spent. The narrator also noted how emboldened people became once they sensed the epidemic's end. Many still died but the conviction grew that if one got the disease, it would be more easily cured. Of course Defoe had written his "eyewitness" account 57 years after the epidemic. Surrounded by death, Rush looked to god, not to statistics. "O! that God would hear the cries and groans of the many hundred and perhaps thousand sick which still ascend to his throne every hour of the day and night from our desolating city!"
Others began giving the all clear. For the first time since September 11, less than 40 were buried. The Gazette knew of no one sick. A correspondent asked if it was not time for the rest of the country to reopen communication with the city. On the 25th the Gazette reported that stores were opening, families returning, the wharves "once more enlivened," as a London ship came up to unload. On Saturday the 26th the market was almost back to normal, "with every species of vegetable product - fowls, butter, &c. &c." The Committee still thought people outside the city should wait another week or 10 days before coming back in. It also published directions for cleaning houses that had been closed up. They should be aired out for several days with all windows and doors open. "Burning of nitre will correct the corrupt air which they may contain. Quick lime should be thrown into the privies and the chambers whitewashed."
John Welsh reported that it was dangerous to walk on the streets "so common is washing windows." The high on the 28th was 37 degrees. John Mease cheered the "cold wind, which... leaves no longer room to hesitate about return of the inhabitants, and is corroborated by the new faces we begin to meet in the streets." Better still his son James, the doctor, was "in a good way, crying hunger all day long." On the 31st a white flag was hoisted over Bush Hill with the legend "No More Sick Persons Here."
On November 2 a list of 7 reasons why God visited an epidemic on the city signed by Jeremiah was published by the Federal Gazette. In his letters to his wife Rush did not allude to or even hint at writing it, but Jeremiah was his favorite prophet and the first two reasons were Rush's particular peeves: lust for wealth "excited by our systems of paper credit," and "rack rents." The first reason condemned his nemesis Alexander Hamilton. And Rush was mad because his rent had just been raised. The five other reasons were more traditional: attending the circus and theater, breaking the Sabbath, swearing, neglect of religious instruction in schools and pride in luxuries.
Rush couldn't shake off gloom and doom. "Many, I fear, will die with [the fever] in the course of the next month from ignorance or carelessness," Rush wrote to his wife on the last day of October. "The citizens are crowding into town every day. I wish they may not repent their coming in so soon." Rush proved to be a prophet. The white flag had to be struck. On November 2 a silversmith named Brooks who had been in the city a week died of the fever. Margaret Morris warned relatives that there was "still the seeds of the contagion lurking in our city and in the corners of many houses which have been shut up as soon as the family have died.... Depend upon it we shall hear of the fever beginning to rage again." The return of muggy weather did not help.
Joseph Dawson dreaded the consequences of that and confessed "for my own part I feel more debilitated than at any period for these six weeks past." In a published notice Rush did not forbid return but recommended that houses be aired out 3 to 4 days and nights, and that returnees avoid "cold, fatigue and intemperance." On the 4th the Committee could "not say that it was totally eradicated."
Impatient at the equivocation in the city Governor Mifflin in Germantown prompted his port physicians James Mease (said to be "a walking skeleton") and Samuel Duffield to declare that the disease had "rapidly declined" and would be gone in two weeks, so Congress could meet as scheduled. Within three days Mifflin returned himself only to be confronted with reports that a ship from St. Domingo with passengers sick with yellow fever was below the city. He sent Samuel Duffield and Deveze to investigate and they found very few sick but many wounded soldiers from recent fighting on the island. To avoid any panic Mifflin ordered the ship to stay at quarantine.
One bureaucrat's wife told her husband that he "must not think of going" into the city. Rumors became so virulent that they even gave John Welsh pause. He knew of one dead, he wrote to his boss, and "several others who had come in are sick, and some every day are going off with death. The disease is very unaccountable, and our men of the deepest knowledge, know but little of it." On the 6th a committee of New York merchants recommended the continuation of the quarantine. Fearing that merchants would buy infected clothes cheaply in Philadelphia and sell them in New York, the health committee there decreed that all goods brought in from Philadelphia had to be unpacked and exposed to "open air" for 48 hours. Clothing, linen or bedding had to be "washed in several waters," then smoked "with the fumes of brimstone for one day."
But people still returned to the city. On the 7th Margaret Morris marveled at the streets "full of people and waggons loaded with furniture." She still warned her family not to come, but on 9th to her joy and surprise, her remaining son and Benjamin Smith's partner, Samuel Emlen, came in for a tearful reunion. President Washington made a day trip to the city on the 11th, despite Attorney General Randolph warning that "we have not yet learned, that any radical precautions have commenced for purging the houses and furniture." One returnee found the city "beautifully clean, nothing lying on the streets or gutters." On the 13th stages north and south were running. John Welsh reported that the streets were "in an uproar and rendered the wharves impossible by reason of the vast quantities of wine, sugar, rum, coffee, cotton & c. The porters are quite savvy and demand extravagantly for anything they do." On the 14th the Committee announced that while houses still had to be purified and infected clothing and bedding "washed, baked, buried or destroyed," anyone could come to the city "without danger from the late prevailing disorder."
Still convalescing, Rush spent most of his time reading, principally Sydenham, and working on his notes about the epidemic. As a visiting physician at the Pennsylvania hospital his rotation for visiting patients was slated to begin on November 2, and he flattered himself that he would be able. He wasn't, which caused no problems. The other staff physicians came to him to discuss the case of a patient who needed an amputation. His good friend Samuel Coates was president of the hospital and dropped by frequently with news of the reviving city. Coates saw the state Rush was in, and loaned him 50 pounds. Rush's major preoccupation continued to be his colleagues. He recoiled at letters from people in the countryside, including Julia, that suggested he was being hailed as a hero in the city. "This is far from being true," he wrote to Julia on October 24. "The relations and patients of the physicians whose practice I have opposed have taken part with them in their resentments, and I am now publicly accused at every corner of having murdered the greatest part of the citizens who have died of the present disorder." He longed to end his days teaching in New York. In Philadelphia, he saw nothing "but strife and misery."
This bitterness became like a refrain in all his letters. He heard rumors that patients of his enemies were surreptitiously saved by the new remedies. "Dr. Wistar's brother has been recovered..., by three bleedings in one day and by a strong dose of the mercurial medicine." French doctors "destroyed at least two-thirds of all who have perished by the disorder.... One of them (a Jew) does not even feel the pulse of his patients. Upon being offered a hand for that purpose by a Mr. Morrison, he said, 'No - no. I never feel the pulse - that is the way the Philadelphia physicians catch the disorder.' This man died on the 3rd day." He blamed John Todd, Jr.'s, death on a French doctor.
During late October and early November, there were no published attacks against Rush. He heard that Currie had written to Hodge attacking Rush's behavior during the epidemic, claiming that he had personally profited from the sale of calomel and jalap. To his wife Rush denied taking a dime for medicine. He had sent patients who could pay to the apothecaries so he could save his supply for the poor. As much as the letter upset him, he was eager to get and publish a copy. "It will show that I had a more formidable monster than the disease to contend with during the late calamity."
He heard from a young colleague, Dr. Michael Leib, that Dr. Barton had intended to try to expel Rush from the College of Physicians unless his friends will plead in his behalf that he was "insane." Rush had already resolved to quit the college. On November 5 he sent a one sentence resignation, and a copy of the Works of Sydenham. Less the symbolism of that be lost on the public, he saw that the weekly Gazetteer printed an "extract of a letter from Philadelphia," that explained that Sydenham had written the Bible of medicine. If the members of the college had been better acquainted with it, the death toll from the epidemic "would not have so greatly swelled."
Some colleagues pleaded for him to remain in the college, and Julia's letters tried to sooth him with praise for his works from the Governor on down. She advised him not to get so upset at colleagues who had not earned the credit he had. He promised to "attend" to her advice, then wailed "Indeed I never intended to begin a controversy with them. I have hitherto calmly contradicted their falsehoods. Dr. Hodge (stimulated by the Wistar family) leads the van of my calumniators. I gave him no other offense than declining to consult with him...." To do so would have been like "a Jew and a Christian attempting to worship in the same temple.... I did not take this decisive step with my brethren till I made myself hoarse in trying to persuade them to adopt the new remedies, and until they had accused me in the newspapers of murdering my patients by bloodletting. The die with them is cast. I feel as if I were more than able through divine support to meet the gathering storm." He did admit that since more people had come to town, he had heard enough encouragement so that he was satisfied that he would "not be driven from the city." He was sent for by one of Kuhn's wealthiest patients.
Well served by his connections in the press, articles favorable to Rush and his methods lampooned his opponents. Benjamin Duffield who worked at Bush Hill was reportedly duped by four prison inmates into thinking they had the fever. He had them sent to the hospital where they robbed some nurses and escaped. An article told the tale of "the foul-mouthed Ben," who approached patients with "an over-dose of New England drinkabus" as a preventative. He asked no questions and thought the state of the pulse "of no consequence in the yellow fever." Shortly after that appeared a lampoon of "Dr. K___", who "never smiled in his life, except at the rise of stock," and a disciple who killed six patients with, respectively, chamomile tea, gin, laudanum, beef broth and "cayan pepper," bark, and killed the last by refusing to bleed despite the patient's begging to be bled.
Meanwhile, as the epidemic wound down, not a few of Rush's patients died. He had an explanation for each one. George Bullock had concealed his illness. Then after Woodhouse had stabilized him, Bullock was poorly attended by an ignorant nurse. Rush's cousin Parry Hall died because after sitting up three nights with his dying sister-in-law nothing could have cured him. Rev. Dr. William Smith's 70 year old wife died because she was so depressed at the death of friends that she was beyond the power of bleeding and purging.
Even with the epidemic ending Rush saw to it that testimonials from those cured by his remedies were published. Dr. Griffitts had been bled seven times in four days, and complained "what shall we say to the physicians who bleed but once." The bookseller William Young wrote that the bark failed when 10 in his family were sick. Rush was too indisposed to attend, but they followed his printed directions and all recovered. The leaders of the African American nurses Jones and Allen visited Rush and told him how they filled in for doctors and "recovered between two and three hundred people" by following Rush's directions. Very likely at Rush's suggestion, Jones and Allen reported their success with Rush's remedies in a letter to the Federal Gazette.
As the epidemic ended, Rush's remedies were not what worried his fellow citizens. Many were alarmed that his theory on the origins of the fever would cripple the city's economy. Richard Peters, a federal judge then in the countryside, had a townhouse a few doors down from Rush. He well knew the passion and persistence his neighbor brought to any controversy. On October 23 he warned Pickering that Rush's "assertion that the Philadelphia hot beds produced this deadly plant is I believe unfounded and I am sure very mischievous," and would be "eagerly caught at by the anti-Philadelphians." The book publisher Mathew Carey wrote a brief history of the epidemic on October 16 that was in a newspaper a few days later. He dismissed Rush's theory on the epidemic's origin, noting that "several other gentlemen of the faculty believe that it has been brought from the West-Indies, which is the most probable opinion." The stock broker Matthew McConnell wrote a friendly but blunt letter to Rush reminding him that his theory was "a dangerous one to advance if not true considering the consequences that might result there from to the city as the seat of the government."
Rush replied that "the good opinion of the citizens of Philadelphia was now of little consequence to me." Rush lumped opponents of local origin with those who attacked purging and bleeding. McConnell assured him that he had "numerous" friends. "In the company I was in,... you were spoken of respectfully and no suggestions thrown out against your practice." He begged Rush to stand his ground. The doctors who had deserted the city had lost their reputations.
Rush must have smiled at the naivete of the layman. The cause, nature and cure of the disease were all linked. His readings of Sydenham and others, whose theories were influenced by the Great Plague, helped him understand how the Philadelphia epidemic could be used to elucidate the nature of all fevers. With the help of old students working in other cities, he was able to see through the claims of rival cities that only Philadelphia had the fever. He had been getting letters from around the country describing dangerous fevers in places unvisited by ships from West Indies or refugees from Philadelphia.
Obviously the fevers arose from local conditions replicated in several places that summer. From his vantage at the eye of the storm, he was able to perceive a sea change in the nature of disease in America. The epidemic's end did not allow him to forgive opponents, writing off their obstinacy as arising from the emotions of a terrible moment that visited the city every 30 years. Their continued obstinacy and persecutions of him stood in the way of his putting an American stamp on medical theory and practice and saving the whole country from the advent of a deadlier grade of fevers. Rush told his wife he was waiting for permission to use the names of his correspondents. Then he would publish his proof of the local origin of the disease, and after that an extensive memoir that would make the epidemic the stuff of medical history.
Julia was waiting for her husband to come and get her. Appealing to his chivalry she had suggested that in honor of her sacrifices she deserved to be escorted into the city by him. Physically he was still tentative. He told her that nothing would please him more than riding out to Princeton to get her. On Sunday the 3rd he went as far as the farm where baby Ben was staying. "My emotions upon his being brought near me (for I did not get out of the [carriage] chair,) may more easily be conceived then described." He took the precaution of only meeting people in the fresh air for fear of spreading infection, and would not let any one in the countryside some within 5 or 6 feet.
He decided he did not want his family to return to an infected house. So he began looking for a new house to rent. In case he was unable to get one soon enough, Marcus got to work "preparing and purifying the house." All the furniture was placed in the yard over night. Rush worried that "no frost has touched them." On November 8 he decided that all contagion had been discharged from his body. His pupils contracted "to its natural fire" and he began having regular bowel movements. But after a trip in the countryside on the 12th he felt "somewhat indisposed" and returned home to take calomel.
Julia realized she was not going to get an escort to the city. So she came to the farm where baby Ben was and sent word to her husband. She missed getting the letter he wrote to Princeton on the 11th worrying that four people had died of yellow fever that Sunday, one "from the contagion lodged in a surtout coat which her son brought into the house." But upon hearing that she was at the farm, Rush relented. He couldn't go out to see her, he explained, because he had a patient "with a disorder which cannot bear the loss of two visits a day at a certain hour without risk of his life." And he feared the ride out and "first interview" with her would be too exhausting. So he sent Fisher out to bring her in, if she wished. "If you come to town, you shall have the front room (now the purest in the house) to yourself. I will sleep in the room adjoining you with the door open between us."
On the 13th she arrived. "My wife wept," Rush wrote in his notebook "and was unable to speak for near a minute. She spent the day and night with me and returned the next day to Princeton." Their daughters were still there, and she was uncomfortable in the infected house. Rush promptly rented another. On November 22, exactly three months after the celebration for the African Church, the entire Rush family was together once again. The epidemic was over.
Go to chapter 12
Monday, March 23, 2020
10. Nothing but the Power of the Almighty
On the morning after he wrote the letter to Rodgers, Rush must not have been feeling well. The postscript he added Friday morning
to the letter he wrote to his wife Thursday evening was longer than usual and more somber. There were clouds lowering, but he was sure it would not rain. "Not a ray of alleviation of the present calamity breaks into our city from any quarter. All is a thick and melancholy gloom." Everyone prayed for a change of weather. Rush thought heavy rain would purify the atmosphere. Cold, and it was getting colder with highs in the 60s over the weekend, was problematical. It would be good for those already sick, but could debilitate the healthy. Frost was another matter. That had long been god's specific against autumnal fevers. But there was no sign of frost. Rush thought the only blessing was that, "men now talk of God and of his providence who appeared scarcely to believe in either two months ago."
An admonition in a newspaper probably caught the tone of many sermons given at the time. Even if the sickness should end, argued the anonymously written letter, "unless the moral causes cease to operate, it will return again, or something more terrible in its stead." Citizens must remember the Sabbath and stop visiting tippling houses, "singing of profane songs," playing instruments and cards and keeping servants at work on that day. The greatest sin of the New Theatre was that "many tradesmen were employed on several Sabbath days successively in working on the building." The writer quoted Leviticus 26:21: "And if ye walk contrary unto me, and will not harken unto me; I will bring seven times more plagues upon you according to your sins." One preacher attacked the New Theater as "a sink of sin... appropriated to the service of the devil."
Rush tried to rally his diminishing strength and at least visit patients near his house. During one of his first visits, where two fever victims were confined in one small room, he suddenly sunk down upon a bed, with a giddiness in his head. It continued for a few minutes, and was "succeeded by a fever." He went back to his house, and wrote to his wife that the "slight attack" went off "in an hour or two with a gentle sweat."
He assured her that he stayed home "in as much health and spirits as usual, prescribing constantly for such persons as I was unable to visit, particularly for the poor." He blamed his indisposition on doing too much the day before, "I was forced by the entreaties and tears of persons who stopped my carriage in the streets to visit many more people than I had intended...." He seemed to view with equanimity the consequences of his indisposition. Coxe and Fisher had completed his visits, except they could not get to Father Fleming, the Catholic priest, in time. Rush feared he would die, "in consequence of my inability to visit him at the usual hour. The delay of a day, nay of a single hour, in administering the remedies proper in this disorder, is often attended with irretrievable consequences." (Fleming died on Sunday.) That said, he was quick to assure Julia that without the new remedies the fever would have been as deadly at the plague.
While Rush seemed too exhausted to rethink his remedies, other doctors in the city rethought theirs. Dr. Hodge thought the disease had changed its character no less than four times, and so he adjusted his remedies. Medical historians might later chastise Rush for concocting the worst of treatments for yellow fever, but on the scene more doctors began to appreciate the relief purging and bleeding afforded the patient. At the end of October Ebenezer Hazard wrote a paragraph on treating the fever for a New England newspaper. He most likely consulted with Hodge before writing it, and far from ridiculing Rush, Hazard wrote, "it seems now to be agreed that bleeding and purging, according to the state of the pulse, are necessary in the beginning; and bark, wine, and nourishing food, as soon as the disorder is checked." Purging and moderate bleeding were prescribed by all but French doctors. Even William Currie began using Rush's methods until he himself got sick.
On the streets of Philadelphia the trouble was not the treatment but the fact that in the first week of October there were some 8,000 sick, and at times only two American and a handful of French doctors able to treat them. (Among the many sick doctors, only Dr. Graham, who had come back to the city from New York, subsequently died.)
At last Rush's house boy Peter "yielded to the disorder." Despite the frown on Peter's face, Rush slept well and crowed to his wife in the morning: "How precious is sound sleep in a city where thousands now pass wearisome and sleepless nights! How great is the gift of life in a place where upwards of a hundred fellow creatures die every day!" He did little that day, save see that Peter was bled. He was amused at the boy's being "terrified with the fear of dying," and Rush "endeavored to improve upon his fears by setting before him his wicked life."
The city received a jolt of optimism when the Federal Gazette announced the arrival of a French doctor named Robert, who promised to serve the poor "gratis - they are Americans, they are the brethren of the French patriots." The merchant Miers Fisher, who was one of his first patients, found his methods "easy and simple, differing exceedingly from Dr. Rush's practice." "He reprobates the mercurial purges and violent bleeding," Fisher told John Welsh, "he makes great use of barley water, tamarinds, and a gentle purge compound of manna, tamarinds and four other ingredients." In all patients, Fisher said, he had "met with uncommon success."
One newspaper correspondent urged the adoption of "the French mode of living;" less meat and more soups, avoid brandy, spirits or strong wine, and dilute beer with water, avoid black and green teas, and eat vegetables and fruits. "The effects are visible - a cheerful equal mind, and a constant flow of spirits...."
That newspaper chatter did little for the bewildered city. Thomas Bedwell, a "gentleman" who lived on Front Street, distributed medicine to the poor, and he took in "a poor woman, a stranger, with her child 4 months old, both friendless and destitute, having lost her husband." He had never done that before. "All things seem now like a dream," he wrote, "this day I call to see my friend, tomorrow I hear of his death, this has been the case in continual succession until I feel myself sunk down and totally bewildered by melancholy events."
Although he cited his missing a visit as reason enough for a patient to die, Rush encouraged people to carry-on without him by liberally using mercurial purges. The fully recovered Margaret Morris treated her maid Sally, who seemed to have a mild case, "as Dr. Rush directs." Then she began vomiting "blackish stuff and the discharge downwards was the same, and then she vomited blood." Morris "began to make experiments." She had Sally lick salt and alum and then quenched the resulting thirst with elixir of vitriol, vinegar and water. Her discharges stopped for 24 hours. Then she started vomiting blood again, "It came out like a teapot." Morris went to her neighbor Rush and got medicine to stop the vomiting, but the bleeding continued and Sally's mouth, tongue and lips were as black as ink. Morris gave her bark, and she recovered. The convalescing Rush told Morris that the spontaneous bleeding cured Sally.
While Sally was sick, William, an apprentice who was staying with Margaret, was seized. She started him with purges and Fisher stopped in to bleed a pound of blood out of him in the morning and another pound that night. He seemed weak but better. No sooner were the patients in her own house stabilized than Benjamin Smith reported that his three servants were ill. With medicines in hand Margaret went to Front Street and purged everyone. Then the two Smith children felt ill.
Back on Walnut Street Margaret's cousin succumbed to the fever. "Practice had made me bold," Margaret later wrote. She gave her cousin a purging powder, and had her bled. Then the two grandchildren living with her got sick. She had not thought the Smith children truly touched with yellow fever, but she had no doubts about the Morris orphans. She asked Rush how to proportion the medicine to the children and dosed them both. One recovered quickly the other didn't. Then the two blacks she had hired to take care of Sally and William got sick and left.
With all the sickness, she wrote, "it seemed as if my heart had died within me." To care for all she decided to spend the days at the Smith house and nights in her own house. Benjamin Smith managed to find doctors to see his ill servants. They too had faith in Rush's methods and the servant with the most obstinate fever was bled to the point where he was "low indeed" and "cold at the extremities" through the night. On Wednesday October 9th a doctor and Margaret Morris both visited in quick succession. The doctor allowed the three servants "restorative medicine." "My mother-in-law, who has had much experience in the disorder,..." Smith wrote to his father, "thinks the crisis is past with both and they will do very well." Of the children only his daughter didn't get well. She "can't be got to take medicine but with difficulty nor then in sufficient quantity but we shall try her again."
Benjamin was the calm point in the storm, reporting with scant emotion that he was able to do as much as he commonly did. But his wife Debby was fatigued, a condition that was no longer dismissed lightly. She "has taken some medicine which I think will prevent any bad consequences." Her mother Margaret had come to have a great belief in bleeding. For a day she sent for a bleeder in vain - eight were unable to come. She never was so bold to try herself. Finally one came and Debby was bled.
On October 5 Benjamin's father sent down a bundle of dried herbs that he thought might be useful, including "tanzy, wormwood of two sorts, one Italian, cardes, balm, isip, pennyroyal." He recommended chewing the wormwood to prevent infection and told of a Frenchman who feared that his servant had the fever. He "was very earnest in inquiry after cardes benedictus or the blessed thistle." It had been hailed in 1578 as a cure for the plague, and the servant recovered with only a blister and the herb given as a tea. There's no evidence that Benjamin Smith used the herbs. He respected his mother-in-law's respect for Rush's methods, which he knew was borne of her observation of several cases.
Historians try to distinguish between home remedies and doctor's medicine, contrasting the good works of matriarchs like Margaret Morris with the insensitive prescriptions of doctors like Rush. Actually Rush worked well with the mothers of the city. Rush was overjoyed when another widow visited him and told how she cured herself with several mercurial purges and by having herself bled seven times in six days.
Yet the chief solace in that most deadly week of the epidemic was not Rush but religion. On October 5 Rev. Helmuth visited "about thirty" sick people, 12 were near death. In the evening as he walked through the empty streets, he achieved a measure of ecstacy: "Blessed evening - blessed awful solitude - The thought: The city is distressed - so many families are distressed - but the Lord looks down upon the distressed, and who would not willingly be in a place on which the Lord looks down in mercy? This thought had so much comfort for me, that I forgot all the calamity around me...." Helmuth shared his insight with all who would listen."Talked to two Quakers," he wrote a few days later, "and tried to convince them that this was a very blessed time for Philadelphia. One of them was moved and started to cry."
Rush did not recover his health quickly and judging from letters to his wife increasingly sought solace in religion. That his "divine Master performed many or perhaps most of his laborious acts of love to mankind with a much weaker body" kept him "from repining." He sent his wife "a sweet little psalm by Watts" that he cut out of the newspaper. The English divine's rendition of the 41st Psalm had timely language: "Blest is the man whose bowels move,/ And melt with pity to the poor,...."
No amount of religion could ease his constant worry about the renown of his methods. He agonized over others misinterpreting it. "They know but little of the obligations of Christianity who give such a worthless reptile as I am the least credit for any one exertion in the cause of humanity, for I profess to believe in and to imitate a Saviour who did not risk but who gave his life, not for his friends but his enemies." He scored one coup when Rebecca Blodget, the daughter of Dr. Rev. William Smith past provost of the university and possessing a considerable following both religious and political, recovered using his remedies. Counterbalancing that triumph was that Mayor Clarkson's wife and Mrs. Kepple were "bad subjects for the disease and unfortunately both my patients."
On Sunday October 6 Rush managed to visit three patients. including Dr. Griffitts. He had been sick early in September, but this time he was worse. Rush was unstinting in ordering Griffitts bled, except during one visit. He found the patient with a "full and tense" pulse and was about to summon the bleeder when he noticed that the window was closed. After opening it, the cool air eased the pulse in 10 minutes. Rush ordered a purge instead and had Griffitts bled again that evening.
Rush resumed his regular practice on October 8, election day. His letter to his wife began with a praise to God from Lamentations 3:23. He claimed he had never had a better night's sleep and in an instant was off to see patients. Rush never mentioned if he voted. Only 567 did in the city. The usual poll was at least 2000. Mifflin, who at the beginning of the year seemed in trouble, won handily in the distracted city and state. (This despite rumblings that Mifflin had helped cause the epidemic. "Do I not know that the governor of our state is a man who has not god in all his thoughts," Julia wrote to her husband after hearing a rousing sermon in Princeton.)
Rush's first patient on Tuesday morning was Timothy Pickering's son. In early October Pickering had written to a friend in Massachusetts that he had "such confidence in the safety of Dr. Rush's practice that my fear of the disease is greatly abated." He and his family were careful to follow Rush's strictures. "We eat largely of bread and vegetables, little or no butter, but molasses and honey instead thereof, barley soup, and very little meat. We drink no wine but use porter much diluted with water, tea, coffee and chocolate. And we are careful to keep the body gently open. Castor oil we find most convenient for this purpose, taken about once a week." Most people died, he thought, from want of care. "Many have been abandoned by their friends, and left in the hands of negroes and other ignorant mercenaries."
A few days later a maid and his six year old son Edward got the fever. The maid recovered while groaning "loudly" about the purging and puking. After getting the same medicine, his son didn't recover, and "... he refused to take anything and in answer to his mother's importuning said his throat was stopped," Pickering wrote to Rush and asked if glysters were in order. That night mother and father administered three and at sunrise the boy passed a stool. The fourth glyster "was followed by several small evacuations," which seemed to relieve him. Then the boy puked dark matter. Before he had only puked while being bled. Pickering thought the "critical moment" had arrived and begged Rush to hasten his visit. Pickering and Rush did not record the last measures they tried before the boy died. Unlike a grocer who wrote to Rush blaming his daughter's death on "the drastic operation of the mercurial purges," Pickering did not blame Rush.
Unlike other times his return to the fray did not seem to invigorate Rush. When he wrote that evening he mainly reported depressing news. Two more allies, Drs. Parke and Physick, were sick. A story that an old enemy had called for him as he lay dying proved false. The old enemy had expressly instructed that if he got sick only a French doctor should be called. He died that morning. Samuel Meredith was sick again and Rush sent Fisher out to see him. Dr. Redman's daughter was "in danger." Her father at least was well and "full of praises to God and love to the whole human race." In closing his evening letter to Julia he added that she could not use any of the dresses in the house because the whole place was so infected. "Nearly an hundred people discharge their infected breath in it every day, for many people in the first stage of the disorder are able to walk about and to call upon a physician." Before he retired he read the 102nd Psalm:
In the morning many asked for him. Dr. Mease, himself "most violently attacked again," urged Rush to see his neighbor Daniel Offley, who had been recovering but "presumed too much on it and it threw him back again." Rush was too weak to go, writing to his wife that he declined all calls that day.
In his memoir his recollection of that day, October 9, was different. He recalled visiting many patients "and, as the day was warm, I lessened the quantity of my clothing. Towards evening I was seized with a pain in the back, which obliged me to go to bed at eight o'clock." His most vivid recollection of what happened after that is a November 8 letter he wrote to Julia: "At one o'clock, I was attacked in a most violent manner with all the symptoms of the fever. Seldom have I endured more pain. My mind sympathized with my body. You and my seven dear children rushed upon my imagination and tore my heartstrings in a manner I had not experienced in my former illness. A recovery in my weak and exhausted state seemed hardly probable. At 2 o'clock I called up Marcus and Mr. Fisher, who slept in the adjoining room. Mr. Fisher bled me, which instantly removed my pains, and then gave me a dose and an half of the mercurial medicine. It puked me several times during the night and brought off a good deal of bile from my stomach. The next morning it operated downwards and relieved me so much that I was able to sit up long enough to finish my letter to you."
He began that letter, "after a comfortable night's rest I rose this morning at 7 o'clock and have ever since been in the midst of sickness and distress." He decided not to describe how serious his attack had been so that she would not feel compelled to come into the city to nurse him. However, he didn't go so far as to claim he visited patients. He only mentioned that there just seemed always to be "eight of ten people" in his house.
That afternoon his fever returned sharply, and he felt very tired, which he thought an alarming symptom. Fisher bled him which revived him. His letter to Julia that night was depressed, noting the great mortality among the poor, especially servants. Another Catholic priest who had been his patient died, "and I fear suffered from my being obliged to desert him." Redman's daughter and Dr. Griffitts were better. It was the shortest letter he had written in the relative quiet of the evening.
The next morning he mentioned the return of his fever to Julia. And could manage only to write a few lines, perhaps of self diagnosis: "It belongs to the disease to end in an intermittent in many people,... and what is unfortunate, it will not bear the bark." He no longer saw patients, and even avoided rooms where patients had been. He decided to avoid contagion at all costs. Then on the night of the 11th, as he explained in his November 8 letter, "I fell into just such a fainty fit as I had about the crisis of my pleurisy in the year 1788. I called upon Marcus, who slept in the room with me, for something to drink and afterwards for some nourishment, which revived me in a few minutes, so that I slept well the remaining part of the night. One or two nights afterwards he gave me something to eat, which prevented a return of the fainty fits."
It would be difficult to exaggerate the miserable condition of the city. A letter said to have been written by Rush on the 10th was widely paraphrased in newspapers around the country: "the disorder was now past the art of man or medicine to cure, that nothing but the power of the Almighty could stop it." No one disputed that assessment. Mrs. William Smith had every reason to see a ray of hope. She had just nursed her daughter Rebecca Blodget to health.Yet she wrote to a friend, "it is not possible for me to pass the streets without walking in a line with the dead, passing infected houses, and looking into open graves.... I don't know what to write; my head is gone, and my heart is torn to pieces."
From Lansdowne, a stately mansion outside the city, the British diplomat George Hammond reported to London that there was no appearance of the epidemic's "ravages being checked.... It is certainly one of the most malignant that has ever visited in any age or nation." The city's Episcopal churches finally closed due to illnesses of clerks and sextons.
The fever even invaded the house where Girard forgot the horrors of Bush Hill and lived as if nothing were amiss. After dinner on the 9th Seguin, the young clerk visiting Girard, suddenly felt "bad with the collick and the head ache." He feared he was getting "the plague," and wrote that "it hurted me very much, for I thought if I should be sick they would send me to Bush, to the ospickle." Seguin managed to pull himself together and after helping close Girard's store at 7 p.m., amused himself "with a young Creole,... about 17 years of age and she told of all the accidents that arrive her in her voyage, and she told me she was boarded by 2 privateers, and that they searched them every where...." The next day he had the fever badly. Girard did not send him to the hospital but decided to try a water cure and treat him with a "grand lavage."
Seeing no end in sight some finally fled the city. Others finally left because all their reasons for staying were dead. John Todd's father died, then his mother succumbed and died on October 12. John let his brother take him to the country, to Dolley and his boys. To preserve them John set up his own quarantine, taking a separate room and spending most of the time outdoors away from everyone.
Yet a few came into the city. John Welsh took his fever while on an errand outside the city. He stayed there to recover and when well enough on the 12th came back to get to work. He found the city a "mournful place." The banks were still open so he was able to make deposits to cover his firm's notes. He made visits and was gratified to find the mayor's wife "in a very fair way of recovering." The city was "equally (if not worse) as bad as when I left it, and a great deal more gloomy - little doing, and a few people in the streets." His chief worry was that John Swanwick would die before making good on a $3,000 debt to the firm. There was a pervasive worry in business circles that with so many dying so quickly without a chance to arrange for paying debts that "great derangements will take place and many great losses must be sustained."
The federal customs house had moved to Chester. After payments were made on federal government securities in early October, treasury department register Joseph Nourse left. His head clerk Joseph Dawson became the highest federal official still on the job. He had stayed because his wife had just had a baby and was not yet strong enough to travel. On the 10th he prepared to leave, then his sister-in-law died. While breaking the news to his wife and her mother, he broke down and was unable to leave the city or go to the office. A few clerks remained. Then Thomas O'Hara died, five days after "taking the scent" when he stumbled into a coffin that fell from a cart onto the street. With his death no one wanted to enter the treasury offices.
Only when the post office, which had moved to 4th and Arch Streets, opened daily at 3p.m. were there signs of life. A crowd always gathered for letters. As for the common people, there was no work for those who remained, prompting one correspondent in the Gazette to urge that supplies being sent from the country be used to pay laborers to continue their usual work. Idleness would increase their propensity to get the fever; work would keep their bodies "in a due state of perspiration." However the Committee was in no state to undertake such social engineering. An October 11 letter in a New York newspaper noted that many members were "indisposed, so that the remainder with their multiplied engagements, have indeed a laborious time of it." On the 11th only eight men joined Mayor Clarkson at City Hall. In the past week the number of orphans to care for had doubled to 70. Daniel Offley who had volunteered expressly to supervise their care died that day.
In a October 12 letter to his father, Benjamin Smith contrasted the recovery of his children and wife ("tho weakened in consequence of the treatment she has undergone") and his own good health with the death of "such a man as D. Offley,... how mysterious and unsearchable are the ways of Providence." Throughout the epidemic Smith thought he charted a rational course. Deaths were few in his immediate neighborhood; he stayed mostly in his house; he did receive visitors who had been among the sick, but when he paid visits to the sick he was careful to go only when they were well on their way to recovery. After closing his letter to his father, Smith felt sharp pains in his head and went to bed with a fever. Debby summoned her mother, who thought he looked much like her son John had at first. She sent for Rush, but he was confined and his apprentices all out. Dr. Mease was "too ill to bespoken to." Benjamin mentioned Parke, but he was ill, and then Dr. James, but he was too weak to practice. James recommended Cathrall, who decided that Smith could not have yellow fever because his eyes were not red. Margaret knew he had it and told Cathrall that she would consult Dr. Rush. On the way to Walnut Street she met one of Rush's apprentices who promptly bled and purged Smith.
It rained Saturday night and there was a "strong northwest wind during the whole night." Henry Helmuth wrote, "Perhaps God wants to help this poor city and bring back its health by this wind." The previous week 130 members of his congregation had been buried. Rush did not notice the change in weather. The city had lost his services. "My fellow citizens, I hope will excuse me," he wrote to Julia on the morning of the 12th, "especially when they recollect how often my premature exertions have brought back my fever." On the 13th he wrote to her that he hoped his conduct "will not be offensive to my divine Master..., to go further than I have done would be I fear to 'tempt the Lord' to preserve me out of the ordinary means of his holy and wise providence." The bedridden doctor did no more than react to the mail and think about his family. "I have thought more of you and the dear children within these two days," he wrote to Julia, "than I have done for six weeks." He asked her how many teeth their baby Mary had.
go to chapter 11
Back on Walnut Street Margaret's cousin succumbed to the fever. "Practice had made me bold," Margaret later wrote. She gave her cousin a purging powder, and had her bled. Then the two grandchildren living with her got sick. She had not thought the Smith children truly touched with yellow fever, but she had no doubts about the Morris orphans. She asked Rush how to proportion the medicine to the children and dosed them both. One recovered quickly the other didn't. Then the two blacks she had hired to take care of Sally and William got sick and left.
With all the sickness, she wrote, "it seemed as if my heart had died within me." To care for all she decided to spend the days at the Smith house and nights in her own house. Benjamin Smith managed to find doctors to see his ill servants. They too had faith in Rush's methods and the servant with the most obstinate fever was bled to the point where he was "low indeed" and "cold at the extremities" through the night. On Wednesday October 9th a doctor and Margaret Morris both visited in quick succession. The doctor allowed the three servants "restorative medicine." "My mother-in-law, who has had much experience in the disorder,..." Smith wrote to his father, "thinks the crisis is past with both and they will do very well." Of the children only his daughter didn't get well. She "can't be got to take medicine but with difficulty nor then in sufficient quantity but we shall try her again."
Benjamin was the calm point in the storm, reporting with scant emotion that he was able to do as much as he commonly did. But his wife Debby was fatigued, a condition that was no longer dismissed lightly. She "has taken some medicine which I think will prevent any bad consequences." Her mother Margaret had come to have a great belief in bleeding. For a day she sent for a bleeder in vain - eight were unable to come. She never was so bold to try herself. Finally one came and Debby was bled.
On October 5 Benjamin's father sent down a bundle of dried herbs that he thought might be useful, including "tanzy, wormwood of two sorts, one Italian, cardes, balm, isip, pennyroyal." He recommended chewing the wormwood to prevent infection and told of a Frenchman who feared that his servant had the fever. He "was very earnest in inquiry after cardes benedictus or the blessed thistle." It had been hailed in 1578 as a cure for the plague, and the servant recovered with only a blister and the herb given as a tea. There's no evidence that Benjamin Smith used the herbs. He respected his mother-in-law's respect for Rush's methods, which he knew was borne of her observation of several cases.
Historians try to distinguish between home remedies and doctor's medicine, contrasting the good works of matriarchs like Margaret Morris with the insensitive prescriptions of doctors like Rush. Actually Rush worked well with the mothers of the city. Rush was overjoyed when another widow visited him and told how she cured herself with several mercurial purges and by having herself bled seven times in six days.
Yet the chief solace in that most deadly week of the epidemic was not Rush but religion. On October 5 Rev. Helmuth visited "about thirty" sick people, 12 were near death. In the evening as he walked through the empty streets, he achieved a measure of ecstacy: "Blessed evening - blessed awful solitude - The thought: The city is distressed - so many families are distressed - but the Lord looks down upon the distressed, and who would not willingly be in a place on which the Lord looks down in mercy? This thought had so much comfort for me, that I forgot all the calamity around me...." Helmuth shared his insight with all who would listen."Talked to two Quakers," he wrote a few days later, "and tried to convince them that this was a very blessed time for Philadelphia. One of them was moved and started to cry."
Rush did not recover his health quickly and judging from letters to his wife increasingly sought solace in religion. That his "divine Master performed many or perhaps most of his laborious acts of love to mankind with a much weaker body" kept him "from repining." He sent his wife "a sweet little psalm by Watts" that he cut out of the newspaper. The English divine's rendition of the 41st Psalm had timely language: "Blest is the man whose bowels move,/ And melt with pity to the poor,...."
No amount of religion could ease his constant worry about the renown of his methods. He agonized over others misinterpreting it. "They know but little of the obligations of Christianity who give such a worthless reptile as I am the least credit for any one exertion in the cause of humanity, for I profess to believe in and to imitate a Saviour who did not risk but who gave his life, not for his friends but his enemies." He scored one coup when Rebecca Blodget, the daughter of Dr. Rev. William Smith past provost of the university and possessing a considerable following both religious and political, recovered using his remedies. Counterbalancing that triumph was that Mayor Clarkson's wife and Mrs. Kepple were "bad subjects for the disease and unfortunately both my patients."
On Sunday October 6 Rush managed to visit three patients. including Dr. Griffitts. He had been sick early in September, but this time he was worse. Rush was unstinting in ordering Griffitts bled, except during one visit. He found the patient with a "full and tense" pulse and was about to summon the bleeder when he noticed that the window was closed. After opening it, the cool air eased the pulse in 10 minutes. Rush ordered a purge instead and had Griffitts bled again that evening.
Rush resumed his regular practice on October 8, election day. His letter to his wife began with a praise to God from Lamentations 3:23. He claimed he had never had a better night's sleep and in an instant was off to see patients. Rush never mentioned if he voted. Only 567 did in the city. The usual poll was at least 2000. Mifflin, who at the beginning of the year seemed in trouble, won handily in the distracted city and state. (This despite rumblings that Mifflin had helped cause the epidemic. "Do I not know that the governor of our state is a man who has not god in all his thoughts," Julia wrote to her husband after hearing a rousing sermon in Princeton.)
Rush's first patient on Tuesday morning was Timothy Pickering's son. In early October Pickering had written to a friend in Massachusetts that he had "such confidence in the safety of Dr. Rush's practice that my fear of the disease is greatly abated." He and his family were careful to follow Rush's strictures. "We eat largely of bread and vegetables, little or no butter, but molasses and honey instead thereof, barley soup, and very little meat. We drink no wine but use porter much diluted with water, tea, coffee and chocolate. And we are careful to keep the body gently open. Castor oil we find most convenient for this purpose, taken about once a week." Most people died, he thought, from want of care. "Many have been abandoned by their friends, and left in the hands of negroes and other ignorant mercenaries."
A few days later a maid and his six year old son Edward got the fever. The maid recovered while groaning "loudly" about the purging and puking. After getting the same medicine, his son didn't recover, and "... he refused to take anything and in answer to his mother's importuning said his throat was stopped," Pickering wrote to Rush and asked if glysters were in order. That night mother and father administered three and at sunrise the boy passed a stool. The fourth glyster "was followed by several small evacuations," which seemed to relieve him. Then the boy puked dark matter. Before he had only puked while being bled. Pickering thought the "critical moment" had arrived and begged Rush to hasten his visit. Pickering and Rush did not record the last measures they tried before the boy died. Unlike a grocer who wrote to Rush blaming his daughter's death on "the drastic operation of the mercurial purges," Pickering did not blame Rush.
Unlike other times his return to the fray did not seem to invigorate Rush. When he wrote that evening he mainly reported depressing news. Two more allies, Drs. Parke and Physick, were sick. A story that an old enemy had called for him as he lay dying proved false. The old enemy had expressly instructed that if he got sick only a French doctor should be called. He died that morning. Samuel Meredith was sick again and Rush sent Fisher out to see him. Dr. Redman's daughter was "in danger." Her father at least was well and "full of praises to God and love to the whole human race." In closing his evening letter to Julia he added that she could not use any of the dresses in the house because the whole place was so infected. "Nearly an hundred people discharge their infected breath in it every day, for many people in the first stage of the disorder are able to walk about and to call upon a physician." Before he retired he read the 102nd Psalm:
I am like a pelican of the wilderness; I am like an owl of the desert. I watch, and am as a sparrow alone upon the house top. Mine enemies reproach me all the day; and they that are mad against me are sworn against me....which made him weep.
In the morning many asked for him. Dr. Mease, himself "most violently attacked again," urged Rush to see his neighbor Daniel Offley, who had been recovering but "presumed too much on it and it threw him back again." Rush was too weak to go, writing to his wife that he declined all calls that day.
In his memoir his recollection of that day, October 9, was different. He recalled visiting many patients "and, as the day was warm, I lessened the quantity of my clothing. Towards evening I was seized with a pain in the back, which obliged me to go to bed at eight o'clock." His most vivid recollection of what happened after that is a November 8 letter he wrote to Julia: "At one o'clock, I was attacked in a most violent manner with all the symptoms of the fever. Seldom have I endured more pain. My mind sympathized with my body. You and my seven dear children rushed upon my imagination and tore my heartstrings in a manner I had not experienced in my former illness. A recovery in my weak and exhausted state seemed hardly probable. At 2 o'clock I called up Marcus and Mr. Fisher, who slept in the adjoining room. Mr. Fisher bled me, which instantly removed my pains, and then gave me a dose and an half of the mercurial medicine. It puked me several times during the night and brought off a good deal of bile from my stomach. The next morning it operated downwards and relieved me so much that I was able to sit up long enough to finish my letter to you."
He began that letter, "after a comfortable night's rest I rose this morning at 7 o'clock and have ever since been in the midst of sickness and distress." He decided not to describe how serious his attack had been so that she would not feel compelled to come into the city to nurse him. However, he didn't go so far as to claim he visited patients. He only mentioned that there just seemed always to be "eight of ten people" in his house.
That afternoon his fever returned sharply, and he felt very tired, which he thought an alarming symptom. Fisher bled him which revived him. His letter to Julia that night was depressed, noting the great mortality among the poor, especially servants. Another Catholic priest who had been his patient died, "and I fear suffered from my being obliged to desert him." Redman's daughter and Dr. Griffitts were better. It was the shortest letter he had written in the relative quiet of the evening.
The next morning he mentioned the return of his fever to Julia. And could manage only to write a few lines, perhaps of self diagnosis: "It belongs to the disease to end in an intermittent in many people,... and what is unfortunate, it will not bear the bark." He no longer saw patients, and even avoided rooms where patients had been. He decided to avoid contagion at all costs. Then on the night of the 11th, as he explained in his November 8 letter, "I fell into just such a fainty fit as I had about the crisis of my pleurisy in the year 1788. I called upon Marcus, who slept in the room with me, for something to drink and afterwards for some nourishment, which revived me in a few minutes, so that I slept well the remaining part of the night. One or two nights afterwards he gave me something to eat, which prevented a return of the fainty fits."
It would be difficult to exaggerate the miserable condition of the city. A letter said to have been written by Rush on the 10th was widely paraphrased in newspapers around the country: "the disorder was now past the art of man or medicine to cure, that nothing but the power of the Almighty could stop it." No one disputed that assessment. Mrs. William Smith had every reason to see a ray of hope. She had just nursed her daughter Rebecca Blodget to health.Yet she wrote to a friend, "it is not possible for me to pass the streets without walking in a line with the dead, passing infected houses, and looking into open graves.... I don't know what to write; my head is gone, and my heart is torn to pieces."
From Lansdowne, a stately mansion outside the city, the British diplomat George Hammond reported to London that there was no appearance of the epidemic's "ravages being checked.... It is certainly one of the most malignant that has ever visited in any age or nation." The city's Episcopal churches finally closed due to illnesses of clerks and sextons.
The fever even invaded the house where Girard forgot the horrors of Bush Hill and lived as if nothing were amiss. After dinner on the 9th Seguin, the young clerk visiting Girard, suddenly felt "bad with the collick and the head ache." He feared he was getting "the plague," and wrote that "it hurted me very much, for I thought if I should be sick they would send me to Bush, to the ospickle." Seguin managed to pull himself together and after helping close Girard's store at 7 p.m., amused himself "with a young Creole,... about 17 years of age and she told of all the accidents that arrive her in her voyage, and she told me she was boarded by 2 privateers, and that they searched them every where...." The next day he had the fever badly. Girard did not send him to the hospital but decided to try a water cure and treat him with a "grand lavage."
Seeing no end in sight some finally fled the city. Others finally left because all their reasons for staying were dead. John Todd's father died, then his mother succumbed and died on October 12. John let his brother take him to the country, to Dolley and his boys. To preserve them John set up his own quarantine, taking a separate room and spending most of the time outdoors away from everyone.
Yet a few came into the city. John Welsh took his fever while on an errand outside the city. He stayed there to recover and when well enough on the 12th came back to get to work. He found the city a "mournful place." The banks were still open so he was able to make deposits to cover his firm's notes. He made visits and was gratified to find the mayor's wife "in a very fair way of recovering." The city was "equally (if not worse) as bad as when I left it, and a great deal more gloomy - little doing, and a few people in the streets." His chief worry was that John Swanwick would die before making good on a $3,000 debt to the firm. There was a pervasive worry in business circles that with so many dying so quickly without a chance to arrange for paying debts that "great derangements will take place and many great losses must be sustained."
The federal customs house had moved to Chester. After payments were made on federal government securities in early October, treasury department register Joseph Nourse left. His head clerk Joseph Dawson became the highest federal official still on the job. He had stayed because his wife had just had a baby and was not yet strong enough to travel. On the 10th he prepared to leave, then his sister-in-law died. While breaking the news to his wife and her mother, he broke down and was unable to leave the city or go to the office. A few clerks remained. Then Thomas O'Hara died, five days after "taking the scent" when he stumbled into a coffin that fell from a cart onto the street. With his death no one wanted to enter the treasury offices.
Only when the post office, which had moved to 4th and Arch Streets, opened daily at 3p.m. were there signs of life. A crowd always gathered for letters. As for the common people, there was no work for those who remained, prompting one correspondent in the Gazette to urge that supplies being sent from the country be used to pay laborers to continue their usual work. Idleness would increase their propensity to get the fever; work would keep their bodies "in a due state of perspiration." However the Committee was in no state to undertake such social engineering. An October 11 letter in a New York newspaper noted that many members were "indisposed, so that the remainder with their multiplied engagements, have indeed a laborious time of it." On the 11th only eight men joined Mayor Clarkson at City Hall. In the past week the number of orphans to care for had doubled to 70. Daniel Offley who had volunteered expressly to supervise their care died that day.
In a October 12 letter to his father, Benjamin Smith contrasted the recovery of his children and wife ("tho weakened in consequence of the treatment she has undergone") and his own good health with the death of "such a man as D. Offley,... how mysterious and unsearchable are the ways of Providence." Throughout the epidemic Smith thought he charted a rational course. Deaths were few in his immediate neighborhood; he stayed mostly in his house; he did receive visitors who had been among the sick, but when he paid visits to the sick he was careful to go only when they were well on their way to recovery. After closing his letter to his father, Smith felt sharp pains in his head and went to bed with a fever. Debby summoned her mother, who thought he looked much like her son John had at first. She sent for Rush, but he was confined and his apprentices all out. Dr. Mease was "too ill to bespoken to." Benjamin mentioned Parke, but he was ill, and then Dr. James, but he was too weak to practice. James recommended Cathrall, who decided that Smith could not have yellow fever because his eyes were not red. Margaret knew he had it and told Cathrall that she would consult Dr. Rush. On the way to Walnut Street she met one of Rush's apprentices who promptly bled and purged Smith.
It rained Saturday night and there was a "strong northwest wind during the whole night." Henry Helmuth wrote, "Perhaps God wants to help this poor city and bring back its health by this wind." The previous week 130 members of his congregation had been buried. Rush did not notice the change in weather. The city had lost his services. "My fellow citizens, I hope will excuse me," he wrote to Julia on the morning of the 12th, "especially when they recollect how often my premature exertions have brought back my fever." On the 13th he wrote to her that he hoped his conduct "will not be offensive to my divine Master..., to go further than I have done would be I fear to 'tempt the Lord' to preserve me out of the ordinary means of his holy and wise providence." The bedridden doctor did no more than react to the mail and think about his family. "I have thought more of you and the dear children within these two days," he wrote to Julia, "than I have done for six weeks." He asked her how many teeth their baby Mary had.
go to chapter 11
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