6. Purge and Bleed the Whole Village

"By far, the most highly and minutely furnished specimen of old-school medical production I have ever beheld," complete with gold-headed cane, gold snuff box, and knee and shoe buckles of gold, was one doctor's recollection of Adam Kuhn. It was not in matters of style alone that Kuhn and Rush clashed. Kuhn studied botany, the traditional guide to medicines, with the great Linnaeus. Rush studied chemistry, the new science creating new medicines, with Joseph Black, a pioneer in the chemistry of the air. Rush's students prized their teacher for being modern. Kuhn's students admired their teacher for being rich. It was assumed that Kuhn was as conservative in politics as Rush was radical. Kuhn had been imprisoned for loyalist sympathies during the war. (Rush had written a letter to help spring his fellow graduate of Edinburgh.) But Kuhn had good Republican connections. His step-daughter was married to Benjamin Bache, Franklin's grandson and editor of the pro-French General Advertiser.

On September 11 Bache printed a letter Kuhn had written to a doctor who had inquired about his treatment of the fever. He described in detail his use of stimulants like elixir of vitriol and decoction of bark to treat a patient's debility. He noted the wines he thought best - Rhenish, Lisbon and Madeira diluted with lemonade, and explained how to give a bath: "the patient is to be placed in a large empty tub, two buckets full of water, of the temperature of about 75 to 80 degrees of Fahrenheits thermometer, according to the state of the atmosphere, are to be thrown over him." He noted that such treatments were successful in Philadelphia, as they had long been in England, Silesia, and the West Indies. Kuhn did not even allude to Rush's treatment.

After reading the letter, Rush wrote to his wife that the "increasing number" of patients coming to him refuted Kuhn. His recent cures of four servants at the British embassy "will swell the triumphs of mercury, jalap, and bloodletting." But he could not let Kuhn's letter go uncontested.

Rush wrote a letter that day for the Federal Gazette, explaining how he had used lenient purges and the methods employed by Dr. Redman in 1762 and had lost three out of four patients. Dr. Wistar had had the same experience in his practice. Then he briefly described his reasons for using mercury and bloodletting after purging. This yellow fever was, due to differences in climate and season, not the same as the yellow fever of the West Indies or the fever in 1762. "Prescribing for the name of a disease without due regard to the above circumstances has slain more than the sword." While Kuhn, who had signed his letter A.K., had not mentioned Rush, Rush identified A.K. as Kuhn. Rush charged that, if persisted in, Kuhn's methods of treating the fever "would probably have aided it in desolating three fourths of our city." His methods on the other hand rendered the fever no more dangerous than "a common intermitting fever."

Yet the day he wrote that, the "awful day," Rush admitted in his notebook that he "lost" several patients. In general he blamed the deaths on the patients not taking medicines. He also got an unwelcome jolt from Stall. His apprentice Washington had seemed to be on the way to recovery. Then came a note from Stall explaining that Washington could not survive long. He had not had a stool for two days, despite "10 & 15." His pulse was "tense altho' it is low." Stall asked: "Shall I bleed him?"

Stall's confusion arose because Rush had just instructed him to bleed only when the pulse was "full and tense." Rush's reply is lost. Warner Washington died that day and Rush had trouble sleeping that night. Stall reported that as he died Washington blamed his mistress. But that information got no further than Rush's notebook. A Virginia gentleman had paid Rush to train his son in medicine, and act in loco parentis to a young man alone in the metropolis. Now the boy was dead. In his memoir of the epidemic Rush explained: "On the 11th of September, my ingenious pupil, Mr. Washington, fell a victim to his humanity. He had taken lodgings in the country, where he sickened with the disease. Having been almost uniformly successful in curing others, he made light of his fever, and concealed the knowledge of his danger from me, until the day before he died." Of course, as his letters reveal, Rush knew about Washington's serious condition days before.

In his next morning report to his wife, the pleasure of the Lord was no longer manifest. Rush wrote glumly, "yesterday exceeded any of the days I have seen for distress and death in our city." His response was to once again change his prescriptions. Not only did he tell Stall that it was proper to bleed when the pulse was "slow and tense," he so informed the whole College of Physicians in a letter to them dated the 12th and printed in the newspapers on the 13th. Rush advocated virtually indiscriminate bleeding at ever increasing frequency and volume. "I have bled in one case where the pulse beat only 48 strokes in a minute, and recovered my patient by it. The pulse became more full and more frequent after it."

Just as when he decided to use calomel, Rush embraced bleeding only on the appearance of favorable symptoms, not on the complete recovery of his patients. He had bled his patient, William Sansom, on Wednesday night after he had learned of Washington's death. On Friday the 13th, Sansom's cousin Benjamin Smith reported that Sansom was better Wednesday night and all of Thursday. But on Friday Rush's optimism and the patient's symptoms seemed to vary. Smith wrote that Sansom "had a bad night again and is very poorly this morning, tho' somewhat better. Dr. Rush expresses great hopes of him." But Smith thought Sansom continued "very ill" and was "in great danger."

The refinement of his prescriptions allowed Rush to remain optimistic and energetic. "Bled five myself," he noted and added, "went to Kensington.

Several families called to me. I could not attend them - but called to Mr. Easby 'To purge and bleed the whole village.'" He addressed a letter "To His Fellow Citizens," which was printed on Friday. In it he sanctioned bleeding up to 12 ounces before purging, and thanked God that the success of his remedies made the fever no more serious than measles or influenza, provided his remedies were resorted to in the fever's "early stage."

The timing of the letter was not solely related to his new ideas about bleeding. The letter was his response to the mayor's meeting held Thursday. The root of the civic terror was fear of contagion. Popular report blamed William Sansom's work as an overseer of the poor for his getting the fever. "The risk from visiting and attending the sick, in common cases, at present," Rush explained in his letter, "is not greater than from walking the streets." So friends and family should nurse the sick. He had advised his friends to flee. That was no longer necessary. "The disease is now under the power of medicine."

However, he did not exactly call the epidemic off. Indeed, contagion was virtually universal. People should stay in the city because they "cannot avoid carrying the infection with them" into the country. "They had better remain near to medical aid and avoid exciting the infection into action, which is now in their bodies, by a strict attention to former directions," i.e. avoid fatigue, eat lightly and use vinegar.

Rush did not base his analysis on the pattern of infection. He sensed contagion everywhere. "Every room in our house is infected, and my body full of it," he wrote to his wife. "My breath and perspiration smell so strongly of it that a lady with more truth than delicacy complained to me of it a few days ago." Almost constantly exposed to contagion, he no longer anointed himself with vinegar. "My eyes are tinged of a yellow color," he continued to his wife. "This is not peculiar to myself. It is universal in the city. Even the Negroes who do not take the disease discover that mark of infection in their eyes. On one day my face had for a few hours a yellow hue. Yet under all these circumstances, and upon a diet consisting wholly of milk and vegetables, I enjoy, as to my feelings and activity, a perfect state of health." In his notebook he revealed that he had apple pie and milk for supper every night.

What troubled him was that others also continued to fill the newspapers with advice. In letters to his wife, he bitterly attacked "the prejudices, fears, and falsehoods of several of my brethren, all of which retard the progress of truth and daily cost our city many lives." "Could our physicians be persuaded to adopt the new mode of treating the disorder, the contagion might be eradicated from our city in a few weeks. But they not only refuse to adopt it, they persecute and slander the author of it." As for his letters to the newspapers, he told Julia, "they will... help the people to cure themselves, not only without but in spite of physicians who know nothing of the disorder."

Kuhn was back in print claiming that of the 60 cases of fever he saw most were common remittents. He saw 7 cases of yellow fever, 4 were his patients. Of those 4 he cured 3 and the other was on the way to recovery when Kuhn got sick. Of course that was Hutchinson. An unsigned article, most likely written by Rush himself, attacked Kuhn's methods more pointedly. The writer reminded Kuhn of Sydenham's teachings (The 17th century London doctor was one of Rush's heroes): "no two epidemics of unequal force can long exist together.... The common bilious remittents yielded to the ruthless and solitary despotism of the prevailing epidemic on the 5th of the present month." Therefore everyone with symptoms of fever should take Rush's cure. Indeed, "the great advantage of the mode of cure adopted by Dr. Rush, consists in its preventing, not curing a yellow fever...." The letter concluded by asking Kuhn to keep "his opinions to himself,... and not add to the mortality of the disorder," by lessening "the confidence of some of the citizens in the only remedies which are safe, practicable, and successful (in 99 cases out of 100) in the present epidemic."

In another letter Rush announced that Dr. Penington had assured Rush that with purging and bleeding he had not lost one of 48 patients. Of six patients he had treated by the "West India mode..., he had not saved one." Rush did not mention that Penington himself was then prostrate with the fever.

No sooner had Rush done with Kuhn then a letter from Alexander Hamilton, who was on his way to recovery, suggested that the College of Physicians ask Dr. Stevens about his methods. They varied "essentially from that which has generally been practiced - and I am persuaded, where pursued, reduces [the fever] to one of little more than ordinary hazard." After sending the letter, Hamilton and his wife left Saturday for her father's home in Albany, New York.

Rush's assurances, combined with the news that Kuhn and Hamilton's doctor also thought the fever not so dangerous, did not stop the flight from the city. Indeed, one could praise Rush and still flee. After informing the president that Rush had given his medicines "to upwards of 500 patients," and lost only one, Secretary of War Henry Knox headed for his home in Maine, leaving the president's order to prepare for the threat of a British or French invasion, by procuring 1,000 rifles, 100 tons of lead and 100 tons of saltpeter, unfulfilled.

Secretary of State Jefferson also gave up on his resolve to stay in or near the capital during the international crisis. He left earlier than he had planned, prompted by the death of the New Jersey born painter Joseph Wright, whom Jefferson had met in Paris and then hired to do engravings for the U.S. Mint in Philadelphia. He had done Jefferson's likeness and perhaps the most popular and lifelike etching of the president.

Wright's wife also died, leaving unfinished a portrait he was doing of himself, his wife and their children.

"The true character of man is disclosed," Comptroller of the Currency, Oliver Wolcott, wrote to his father, the governor of Connecticut, "and he shows himself a weak, timid, desponding and selfish being." Many left in the city were perishing "without notice or the least assistance from their friends." But Wolcott himself was soon out of the city. First he removed his family, then his clerks pressed him to stay out of town too. As the terror grew so did his precautions. He advised his clerks who stayed in the city not to send papers to him, unless absolutely necessary, for fear of spreading infection. When informed that a clerk was caring for his son who had a bad case of the fever, Wolcott instructed the clerk not to come to the office. After setting up such roadblocks to continuing business, Wolcott found a vacant house along the Schuylkill and arranged to move at least one clerk from every treasury department office out to it.

However despite such prominent defections, through his publications Rush did gain devoted followers. Father Francis Fleming visited the poor dispensing Rush's medicines, and whenever he saw a doctor who didn't use calomel, he begged them to swallow their pride and save the people. Postmaster General Timothy Pickering had been away negotiating an Indian treaty and returned the first week in September to find a servant and one of his three sons sick with the fever. He called for Rush, and explained to those who asked why he didn't flee that he was loath to leave "the one physician on whom I could depend."

When Margaret Morris regained enough strength to once again become the protector of her family, she ordered all "the little ones" to take a dose a calomel and to repeat it in a week.

Not everyone who stayed in the city put so much faith in medicines, nor did any medical theory explain what was going on around them. The notion of universal contagion neutralized by Rush's 99% effective cure was too extreme to form a basis for civic action. Even a city with such pretensions as Philadelphia was not so modern that it expected doctors to have the answers to an epidemic. The religious saw the hand of god at work. Those not religious discounted the alarms of doctors as well as the divines. People with scant interest in medical or religious theories gathered to serve suffering humanity. An epidemic was a crisis like the occupation by the British, or an Indian attack, or fire, or famine. Those who fled were forgiven, those who stayed served without ulterior motives. The greatest civic sin was to profit from the distress, and perhaps that was why Rush's bragging was so discomforting to many who stayed.

Most of the men who came to the mayor's meeting were hitherto undistinguished shopkeepers motivated by "duty towards the poor," several were Quakers, some Republicans. None had a religious or political axe to grind. The Quaker legislator William West's call to ban theaters in the state was kept alive in the city as the epidemic spread. For example, the German Lutheran minister Henry Helmuth noted that the New Theater was scheduled to open that fall in Philadelphia. He thought it was no accident that the scourge came just when the theater, financed by subscriptions that could have pleased god by supporting poor widows and orphans, was to open. Yet the religiously minded men who came to the mayor's meeting made no controversy about that.

Several of the volunteers were Republican rivals of the Federalist officials who had fled. There was an election scheduled for October 8, but there is no evidence that anyone politicized the epidemic. To stay and perform jobs that would expose one to the sick was not a duty undertaken out of ambition. For example, the Quaker minister Daniel Offley, an anchor manufacture, began his service by giving money to families that lost bread winners. On Sunday the 15th he began going into sick rooms to comfort those who had the fever. Doing that appeared to him "very awful as [the fever] is very infectious." He knew he might "be taken" in "a few minutes." Yet he gained a sense "of peace in visiting the sick."

The French-born merchant Stephen Girard, who paid more attention to Voltaire than the Bible, never wrote about any inner peace that he gained by serving the poor. He merely wanted to exhibit the courage that seemed so lacking in his adopted city. He wrote to a friend blaming "the deplorable conditions" on fear and fright, as much as disease. He had a "slight attack of the fever" in late August, and blamed doctors for creating a panic by treating the disease as the plague. Their "pernicious treatment" had sent many "to another world." He came to the meeting because he was "not afraid of death," and saw no "risk in the epidemic."

Mayor Clarkson, a marine insurer in his sixties, never revealed if he was as unafraid as young Girard or whether he served only because he thought the mayor should not desert the city. He had already proved his lack of political ambition by not accepting a seat in Congress that was his for the taking. He did not open the meeting at the State House by presenting his measures to meet the crisis that he probably grasped better than most. He patiently let the men who had assembled discover the dimensions of the city's desperation. One of the remaining overseers of the poor outlined the crisis at the Bush Hill hospital. The nurses who had been drinking were paid off and fired. A clerk hired the day before reported that the hospital "had received 93 persons;" 38 had died, 11 the night before. There were currently 39 patients, and more always coming. The clerk would make a new count, "God willing I live."

A committee of 10 was formed to investigate the state of the city and decide on what to do next. The latest horror story was about a broker dying of the fever when his wife went into labor. "She opened the window and call'd for help, but obtain'd none, in the morning some one went in to see how they fair'd, found the man and his wife both dead, and a new born infant alive." The committee had to get beyond stories and assemble facts.

One member drove his carriage from one end of town to the other passing five grave yards. He counted "as many as sixty graves, open to receive the dead that evening." And he had not seen Potter's Field. He saw "about ten or twelve corpses carried by negroes, some few people walking after two of them." He learned that if people got sick, "they would be turned or carried out of their lodging - no money would save them, or procure a nurse, except it was a negro. The stage boats were forbid to carry any person from Philadelphia;... the vessels were not allowed to go above Market Street to unload; the stores were nearly one half shut up, and a great number of those open were left with only a single person to take care of the property; the bank was expected to be closed this day, as little or no business is done in it at present." As there was no way to make money, unless one was an African American nurse, the ranks of the poor would soon swell. Actually, the banks remained open.

A correspondent in the newspaper blamed gossiping servants for spreading the disease from infected houses and urged that the sick be sent out of the city, the poor to Bush Hill and the rich to their country houses. "If the Corporation have power to cause all matter to be removed that is impregnated with noxious air, surely those under the infectious disorder should also be removed.... It will be of no advantage to have our streets washed if the diseased remain in their houses."

The committee decided on a humbler plan; support the poor, care for orphans, make the hospital suitable for victims, and urge them to come there. To ratify that, another meeting of citizens was called for Saturday. Meanwhile a committee of three met with the Bush Hill physicians to see what they needed. A notice appeared in the newspapers soliciting shirts and linens for the hospital and offering nurses "generous wages." The four doctors there, Physick and Cathrall were joined by two other young physicians, Michael Leib and William Annan, were avatars of Rush's methods. They asked the committee for a bleeder, that is, a man skilled at taking blood from patients.

Enough men came to the citizen's meeting Saturday to fill the places of the overseers who had fled. Twenty-eight men stood to help Mayor Clarkson. Mayor's committee minutes

The primary need was to identify and help the poor. Each member was advanced $50 to distribute. A committee of three was sent to negotiate a $1500 loan from the Bank of North America. A committee of ten was selected to supervise the hospital. The committee as a whole, "The Committee to Attend and Alleviate the Sufferings of the Afflicted with the Malignant Fever," would meet every day, including Sunday, for the next two months.

The Committee filled the newspapers with its proceedings. There was no better way to assure citizens, in and outside of the city, that something was being done. However, it didn't report bad news: that 8 patients had died at the hospital in one night and that of 43 patients there on the 11th, 20 were soon listed as dead. Removing contagious people from the city would save the lives of those who remained. So despite a lack of beds at Bush Hill which meant that some patients lay on the floor, the Committee reported that "the sick are amply furnished with the necessary supplies and accommodations; and that the business is now so far matured as to afford every assistance necessary." To be sure the Committee also hired a carpenter to make beds.

Other carpenters got to work for the Committee making coffins and discretely stacking them in the State House yard. Samuel Benge, an umbrella seller who had just come from England, volunteered to distribute the coffins to the needy and see the corpses properly buried. Judging from the published minutes Clarkson and Benge would be at City Hall daily for the remainder of the epidemic, supervising several carts that took the sick or supplies to the hospital and the dead to Potter's field. The Committee also solicited and distributed charity. The lawyer John Todd, Jr., was the first to donate to the poor, $20. The Committee promptly distributed aid, giving $5 to Samuel Bullman, whose wife and children were sick (his wife later died,) and 5 1/2 crowns to a widow caring for several orphan children who was "recommended by several respectable citizens for relief."

There was a pervasive fear of crime. Many who fled left servants to protect their houses. Supreme Court justice James Iredell's servant heard of a "set of villains that... take this opportunity of plundering the houses of those absent." One house had been attacked three times." Samuel Massey, a rich Quaker who lived on Vine Street, the northern border of the city near the working class suburbs, fretted at the danger. "Vast numbers" of laboring men left in the city would "commit outrages." There was a call for volunteers to bolster the night watch.

But committees in themselves did little to hearten the community. Stephen Girard sensed the need for quick, heroic action.

He rode out to Bush Hill accompanied by Peter Helm, a cooper. They visited each patient. "No one can imagine the alteration that took place among the sick," Benjamin Smith related the story that swept the town, "at the sight of two of their fellow citizens in health, venturing among them." The visits "diffused universal cheerfulness and seemed no less than a reprieve from death." They went from bed to bed, asking each patient what he or she needed "with a coolness and authority that keeps all the attendants in order." When the hospital committee met on Sunday, Girard and Helm not only provided a list of all that was needed, they offered to superintend the whole operation, spending as much of their time at the hospital as necessary to get it in good order. bush hill committee report

Girard soon consolidated his control of the hospital,replacing the young American physicians with Dr. Jean Deveze, a French doctor who had just come from St. Domingo. Like Girard and unlike the Americans, Deveze believed the disease non-contagious. It grew from seeds formed in the body by long exposure to the debilitating climate of America. The poor diet of Americans and the sickly atmosphere of Philadelphia the past several months brought the seeds to deadly fruition. (Contributing to Girard's courage and Deveze's ideas was that no Frenchmen had died of the disease. "If the disease continues two weeks longer," Girard joked in a letter, "there will be nobody left here but Frenchmen, for they do not die so easily." Most had come to America through the West Indies and gained the immunity assured by exposure to the disease.)

It bears noting that the ease with which Girard and Deveze took over reflected the suspicions doctors and patients had of hospitals. The four American doctors made no fuss after being dismissed. Since hospitals were essentially warehouses for the sick poor, and since the debilitated poor were, according to accepted medical theory, very prone to die of infectious diseases, a doctor mindful of his reputation avoided Bush Hill.

Laymen feared it, too. The carts taking patients out and returning with corpses were "frequently interrupted, insulted and threatened." On Tuesday the mayor placed a notice in the newspapers begging citizens to show some humanity and desist. A passage in Brown's Arthur Mervyn captured the pervasive feeling. "My sickness being suspected, I should be dragged in a cart to the hospital," the hero worried, "where I should indeed die; but not with the consolations of loneliness and silence. Dying groans were the only music, and livid corpses were the only spectacle to which I should there be introduced."

As much as he praised developments there, Benjamin Smith would not think of sending his sister-in-law, even though the continued refusal of her father to take her in scandalized the Quaker community and burdened the Wells family. (One young Quaker castigated Abby's father as having "the heart of a viper." He did check on his daughter by sending a clerk who would knock on the door then hurry back across the gutter and speak to whoever answered.) As much as sending her to the hospital would relieve the burden and embarrassment, the best care was still to be had at home. Indeed Dr. Parke, who used Rush's remedies on Abby, electrified the family by announcing that since bleeding had afforded her such relief, perhaps she didn't have yellow fever after all. Then the next day she sank back into her bed with extreme debility. Her only exertion was to bring up black vomit, which in case after case seemed to be the fatal sign of yellow fever. Parke decided she was beyond hope. Two hired African American nurses were her constant companions, with an occasional visit from a Quaker minister.

Rush paid no attention to the hospital. More poor people came to his house for help than went to Bush Hill. He treated them without charging a fee and his house was much closer than Bush Hill. This was not in response to this epidemic. His policy had its roots in the break-bone fever epidemic of 1780. He had gotten the disease which left a sufferer bone tired for weeks. Rush began refusing to see poor patients. Then he had a dream in which an old woman told him that he would have died of the fever but the prayers of the poor persuaded God to let him recover. Ever since Rush had treated the poor who came to him free of charge.

At his house in 1793 they got calomel and jalap and Rush's apprentices bled them in the yard where blood overflowing the collecting bowls made puddles on the ground. Rush also encouraged his African American friends to purge and bleed the patients they were called to, offering to send his apprentice Fisher to help them. Jones and Allen assured Rush that they already knew how to use the lancet and were following his instruction. A few weeks later Rush would describe the Committee's work as a "forlorn hope." He was the city's best hope. And that Sunday, the day Committee began its work, he received fresh confirmation of that.

He was not feeling well. On Saturday night he returned to a patient, a boy, who lived south of the city. Although he had been bled earlier in the day, Rush thought he must be bled again. In his September 12 letter to his colleagues Rush had reminded them how necessary it was to bleed children even if they did not appear to have fever or pain. It was too late to get a bleeder to come, so he undertook the operation. As was often the case with children, finding a good vein, keeping up a flow and controlling the patient was taxing. Overheated, Rush returned to Walnut Street in the cool night air.

He did not sleep well and fearing the onset of a pleurisy, a recurrent condition with him, he had Stall bleed him. On Sunday the wind came again from the south bringing sultry weather. He visited 20 patients that morning. During one visit he had to lie down to regain his strength. As he comforted the family of his next patient he smiled and explained "you see me here just taking the disorder, and yet I have no fear as to its issue." When he returned home at 2 p.m., he was seized "with a chilly fit and a high fever." He had a taste of his own medicine, calomel and jalap, and went to bed.

Next morning he raved to his wife about his curing himself: "in consequence of losing blood and taking one of my purges I am now perfectly well - so much so that I rested better last night than I have done for a week past. Thus you see that I have proved upon my own body that the yellow fever when treated in the new way is no more than a common cold." Rush told her that he thought his methods could cure the plague itself.

Go to Chapter Seven