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.

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