Benjamin Smith's two year old son Daniel had severe vomiting and diarrhea, and was promptly sent to his mother who was still at the Walnut Street house caring for her mother. Margaret rallied to care for her grandson. She didn't think it was the fever and treated the boy with a soothing cinnamon medicine. There was no room in the house for the worried father, and he was left alone to brood in his counting-house on South Front Street.He wrote to his father that Monday the 16th was the "most fatal day." He blamed the "sultriness" which returned after a week of relatively cool weather. As a friend put it, going into the "lower part of the city" was like"going into a thick cloud." Abby Morris died a little after noon. Over the weekend her body broke out into boils. That morning they began to bleed and nothing could staunch the flow.
A few stores up from Smith on Front Street, John Welsh lived through his worst day. Inthe morning he was relieved to hear that his clerk Josey Gill and most of his family had a "slow fever," not the yellow fever. He thought of visiting their Pear Street house, but, as he wrote that day, "prudence and my own safety forbid it." To that letter he appended a list of the sick and dead, seven by name and "numbers unknown to me" including "a boy now dead at the corner of Pine and Penn Streets." A few hours later he learned of Josey Gill's death. "The reports of mortality today are truly shocking," he reacted. "There must be near twenty dead in Second Street,... and the havoc greater than heretofore, considering the extreme thinness of the inhabitants, being convinced two thirds of the people are now gone to escape."
Welsh still tried to conduct business. His boss wanted rum and candles. Welsh took "some trouble to search the city" before finding the rum. The only candles he could find were"rough and unhandsome," made in Philadelphia not New England. "There is not that choice there used to be," he explained. "So many stores are shut up." The banks did remain open. John Nixon ,President of the Bank of North America, decided that he was safe if he took a carriage to the bank door and went directly to his office, avoiding as much as possible any contact with employees or customers. Welsh was able to make two deposits to cover notes coming due that week.
There was a brisk trade in refugees. Stage companies still offered passage out of the city, but to get passage to Chester, for example, one had to buy a ticket for Baltimore. To get his housekeeper to Wilmington on Monday, Welsh found space on one of Levi Hollingsworth's shallops. Hollingsworth oversaw an extensive coasting trade, but had a devil of a time convincing captains that coming up to Philadelphia was perfectly safe as long as they stayed aboard their ships and didn't venture onto infected ground. Like many who remained in the city, Hollingsworth was loath to admit that the fever had full sway.
The mayor's committee made a point to remind the world that the city was not intrinsically unhealthy. It passed a resolution relieving the city of the onus that the report of the College of Physicians had put on it. Dock side filth did not cause the disease. The city was "much exposed... from the numbers that are daily arriving from foreign parts where infectious disorders are frequently prevalent...."
Of course the rest of the world was hellbent on preventing exposure to the Philadelphia fever. Before leaving Philadelphia, Secretary of War Knox wrote to the president that "the stroke is as heavy as if an army of enemies has possessed the city without plundering it." On the road,Knox met the armies. "The alarm of the people in all the towns and villages on the road to New York... is really inexpressible. The militia are passed at Trenton, Brunswick, Newark and New York." Only Elizabeth-town was hospitable and there Knox waited out a 14 day quarantine which would allow him to travel through New York.
That city had a specially appointed health committee to investigate all reports of sickness. All refugees from Philadelphia were taken to tents in an island in the harbor. A night patrol was formed to prevent secret landings. All people seekingpassage by boat into the city had to get the health committee's permission which they were chary of giving.
James Graham, a Philadelphia doctor then in New York, fumed in a letter home, that New Yorkers wouldn't mind placing guards "round Philadelphia armed with rifle guns and shooting down like black birds every affrighted citizen who would attempt to leave it." Graham laughed at a proposal "to smoke all" from Philadelphia. "I entertained some apprehension, least they should convert me into bacon before I could effect my escape."
Vigilance was as great south of Philadelphia. Treasury auditor Richard Harrison made the passage to Virginia before all the stages were stopped. Still in Alexandria even old friends avoided him. "The consternation (was) greater here than at Philadelphia," he wrote. "Camphor and preservatives are in use with many." No vessel from Philadelphia was allowed closer than a mile. The militia stopped carriages two miles outside of Baltimore. In one case passengers were forced out by armed men, one threatened to shoot Mathew Carey, a Philadelphia publisher, if he stepped "within his line." The passengers were forced to sleep outdoors and not fed until ten the next morning. Carey wrote home about his ordeal and a garbled account that appeared in a Philadelphia newspaper claimed that stranded passengers were offered "a piece of dry cheese on the end of a pitch-fork."
Rush did not ridicule sensible precautions taken by people outside the city. He told his wife that she should "converse with nobody now who comes from Philadelphia. Everything is infected in our city." For Rush, Monday was his first day of rest in almost a month. The community at large probably did not notice because Rush carried on his crusade in the newspapers. An anonymous paragraph echoed what he had written to his wife Sunday morning: "Some persons object to Dr. Rush's mode of treating the yellow fever because it is so simple - requiring only two remedies mercurial purges and bleeding. Such persons should recollect, that a stone and a sling in the hands of little David, brought Goliath to the ground.
In a signed article he suggested measures to keep one from becoming predisposed to the disease. Everyone exposed to the contagion should "live upon a milk and vegetable diet, and take cooling purges once or twice a week." Then the disease, if taken, would be mild. Rush did not spell out the medical rationale for the diet, because it was widely accepted that meat and spirits promoted putrefaction within the body. Nor did he have to explain how sunlight increased putrefaction. He had noticed houses with bedding hanging out the windows, so he cautioned that the bedding and clothes of the sick "should upon no account be exposed to the heat of the sun, but washed in warm, or soaked in cold water." He reiterated that the sick must "by no means... take vomits, bark, wine, or laudanum." He did approve "napkins dipped in pump water...applied frequently to the forehead."
Rush did not completely dominate the media. Responding to Hamilton's suggestion, Dr. Stevens wrote a long letter to the College of Physicians about his methods. To Rush's chagrin it was printed that Monday. Stevens did not mention Rush by name but he did ask "should not violent evacuations which evidently weaken and relax be avoided," given the "extreme debility inanimal functions and great derangement of the nervous system" occasioned by the disease.
Rush immediately complained to Dr. Redman, president of the college, that by printing Stevens' letter the college seemed to endorse his methods. Redman replied that since Hamilton had mentioned that Stevens would explain his methods to the college, it would have been "offensive to the public" to withhold what he wrote. Rush also wrote to the college as a whole complaining that Stevens' letter would "co-operate with Dr. Kuhn's plan... in adding to the mortality of the disorder." If he survived the epidemic Rush promised to prove Stevens wrong. Meanwhile, the explained that the debility Stevens treated was not a direct result of the disease but "arises wholly from an excess of the stimulus of contagion upon the system." The body was so overstimulated that it was collapsing. That stimulus had to be removed by purging and bleeding, which would reduce the disease "to a level with a common cold," provided patients could "be visited by physicians as often, and attended by nurses as carefully, as in other acute diseases." The letter was printed in the newspapers on Tuesday.
Strong enough to carry on the controversy, Rush could not have been that sick. However, away from the battlefield, he could at last reflect on the misery he had seen. "Many die without nurses," he told his wife. "Some perish from the want of a draught of water. Parents desert their children as soon as they are infected, and in every room you enter you see not a person but a solitary black man or woman near the sick. Many people thrust their parents into the streets as soon as they complain of a headache. Two such exiles have taken sanctuary for half a day in our kitchen and shop." He also reflected on his good works. "So great is the apprehension of death from the disorder that I have seldom visited a patient for the first time without being met at the head of the stairs by some member of the family in tears. Good Mrs. Mease took me by the hand the first time I visited her son and was dumb for some time with fear and distress. Another lady... fell upon my neck and wept aloud for several minutes before she would let me enter her husband's room. They were patients of Kuhn's. They proposed a consultation [with Kuhn], but I objected to it. I said I had a confidence in my remedies and that I must attend him alone or not at all. They consented to my proposal, and after three bleedings he recovered."
He couldn't help but notice that Kuhn and Stevens had left the city, "and Dr. Shippen is nobody knows where." Every other doctor who had gotten sick was still unable to see patients.Yet Rush mustered the strength to see people in his house on Tuesday, and even visit some nearby on Wednesday. "I am thankful for this great privilege," he wrote to Julia. "It is meat and drink to me to do my Master's will." Two ministers visited him as he convalesced. "Mr. Fleming called upon me this morning and informed me that he had found in visiting his congregation many people cured by following my printed directions without the advice of a physician. Mr. Helmuth called upon me soon afterwards and told me nearly the same thing." (Helmuth mentioned his visit in his journal: "Met Dr. Rush who is feeling well and confident. Felt bad myself. Lord, your will may be done!")
Rush did not worry about being unable to visit patients. Stall and Coxe, he wrote, "are doing wonders in our city. They visit and cure all my patients." In a letter he wrote to his parents on Sunday Stall marvelled at his suddenly becoming a doctor. "So many doctors are sick, the poor creatures are glad to get a doctor's servant." However not a few families were taken aback when a 19 year old came to treat their loved ones. They wrote to Rush, asking for his opinion and instructions. Throughout his career Rush saved letters from patients and he had no qualms about dispensing advice in letters. Unfortunately, save for some bare notes he wrote on a few letters, what he prescribed in most cases is not known. The letters do reveal how his patients suffered.
Dr. John Mease did not stint in following Rush's prescriptions. His father said he lost 4 1/2 pounds of blood in five days, and had 25 bowel movements resulting from purges. After that Mease's father wrote to Rush wondering if it was time to begin stimulating the patient with "nourishing drinks." What alarmed him was the twitching and starting as his son drifted in and out of sleep.
Alexander Cochran gave the best description of mercury poisoning. The purges were violent, working "pretty severely up and down." The side effects were daunting: "My lips and gums have been much swelled, and the skin excoriated these several days past. In consequence whereof I have spat blood these three nights past, but particularly last night from a half a pint upward." He asked for something to stop his bleeding mouth. If it was not "alarming," it was still "weakening and very disagreeable." Cochran did not submit to bleeding very well. After losing 6 ounces he "nearly swooned away."
In the case of the ten year old son of the prominent merchant Mordecai Lewis, "liquids color'd with blood" continually "rose out of his mouth while sleeping." Rush had some inkling of the problem. After taking his purges he confessed it made his mouth sore. When he began making his rounds again on Thursday, the Lewis boy was one of the first he saw. Rush's apprentice Fisher had bled him and the incision would not stop bleeding. When Rush saw the boy, he changed treatment, using medicines that were anathema in his published statements: laudanum and bark in glysters. To no avail. The glysters would not stay. The father tried to get the medicine down his son's throat but that seemed to strangle him. That night the boy "vomited up a large worm, 8 or 9 inches long and full thick as a quill," and died shortly afterward.
The power of the fever was such that few blamed Rush for deaths, and many lauded his remedies when they preserved a seemingly sick person from having the most fearful symptoms.William Sansom was "reduced extremely low by physick and bleeding," but he didn't have black vomit, and he recovered. So when Richard Wells got a fever, Rush was immediately sent for.
That call on Wednesday morning probably inspired Rush to cut short his own convalescence. Rush's quick, authoritative treatment of his uncle impressed Benjamin Smith. Wells seemed to have a "light" fever, yet "the doctor took every precaution, the first appearances not having always proved a sure presage of its progress - he has been repeatedly bled and has taken freely of the mercurial powders which seem to have operated kindly and... with good effect; his fever is much reduced tho' not quite removed & he spent last night as easy as could be expected when under the operation of his physic." (A week later, Smith found Wells "much reduced under Dr. Rush's mode of treating the disorder.")
By treating patients decisively at the first sign of fever, Rush left himself vulnerable to the charge that it was not really yellow fever he was curing. With Kuhn and Stevens out of town, William Currie took up the dispute with Rush. In an article Tuesday the 17th he recognized that there were "above a thousand ill," but very few had true yellow fever. Rush's treatments worked because most had complex symptoms arising when the "common remittent or fall fever" attacked a person "not fully recovered from the affects of the influenza." In such cases there was "a violent determination of blood to the head, accompanied with acute pain, a redness of the eyes, with a faint tinge of yellow - the pulse is quick and the skin hot." True yellow fever, Currie urged, should be treated by Kuhn's and Stevens' methods. Rush's methods would "bring certain death." Fortunately there were only "40 to 50" yellow fever cases in the city. And the disease was easily avoided by paying "proper attention to fumigating and ventilating the houses, clothing and utensils" used by the sick. If that were done, Currie concluded as he strained to match the always upbeat Rush, "the infection which has proved so mortal, will most certainly be eradicated in a few days.... It is time the veil should be withdrawn from your eyes, my fellow citizens!"
Currie's attack sent Timothy Pickering rushing to Rush's house, where he found young Dr. Physick there discussing autopsies he had witnessed at Bush Hill. Physick had seen marked stomach inflammation and was convinced Rush was right, purging and bleeding were necessary. Physick offered to write something in support of Rush. While pleased at the young man's enthusiasm (he had been a student of Kuhn's,) Rush cautioned him not to mention the inflammation of the stomach because that would "deter others from the use of calomel." The "theory" behind the treatment, Rush explained, had best "be settled hereafter." The next day Physick's letter was in the newspaper endorsing Rush's method against "the most powerful of the inflammatory diseases."
There was a well orchestrated defense of Rush's methods in the newspapers. Rush began it with a letter, written in the third person, which reiterated Sydenham's stricture that "no two epidemics of unequal force can still exist long together in the same place." Rush assured the public "that all the fevers now in the city are from one cause, and that they all require different portions of the same remedies." The fever he had just recovered from must have been the yellow fever since he had been exposed to it for three weeks. Yet he recovered after "two copious bleedings, and two doses of the mercurial medicine, and that too, in the short time of only two days."
Following that there were paragraphs announcing the recovery of Dr. Penington "after five bleedings, and the liberal use of the mercurial powder." Dr. Mease had used the same remedies and was out of danger. An Observer wrote that while not grounded in theory, Rush's cure had "nothing to recommend it at present but its wonderful success." Doctors said his dose "would kill a horse." Observer knew "it has not killed a weakly infirm lady.... On the contrary it has restored her to health and may not the same be said of hundreds who have submitted to his prescriptions." As for the West Indian method, "we are tired with numbering those it has already laid in the dust."
On Saturday the 21st "T.P." (Pickering) weighed in noting the cures in his family and the deaths of neighbors "under other modes of treating the disease." He ridiculed Currie for claiming that Rush's medicines cured the common fever but not the yellow fever. If 1,040 are sick and 1,000 have the common fever which Rush's methods cure, "Fly then, my fellow citizens, from other methods, which have brought so many to untimely graves."
That support did not sooth Rush. As a gadfly reformer trying to cure a wide range of society's ills Rush was used to being applauded and then seeing his prescriptions ignored. But hec ould not tolerate having his expertise challenged in such a crisis. In the best of times Rush saw conspiracies against the forces of good whether his cause be reforming government, religion, education or medicine. This was the worst of times and he could save hundreds who died in agony. His anguish seethed into almost paralyzing paranoia. In a letter to his wife, he claimed that his colleagues had "confederated against me in every part of the city. Dr. Currie (my old friend) is now the weak instrument of their malice and prejudices. If I outlive the present calamity, I know not when I shall be safe from their persecutions. Never did I before witness such a mass of ignorance and wickedness as our profession has exhibited in the course of the present calamity. I almost wish to renounce the name of physician. Even the nod of Dr. Kuhn in his lurking hole at Bethlehem [Pennsylvania] commands more respect and credit from my brethren than nearly 1,000 persons in different parts of the city who ascribe their lives to the new remedies. Our neighbor Davidson died yesterday under the use of bark, laudanum, and the cold bath administered by the hands of Dr. Currie. Indeed the principal mortality of the disease now is from the doctors."
Rush's campaign suffered a set back when Dr. Penington died. Rush saw him that day "shattered by delirium." He wrote a short note for the press explaining that "in consequence of going out too soon after his recovery, [Penington] relapsed a few days ago and is since dead." The death of another doctor caused no shock waves, in part because the weather changed. It was cold Wednesday morning, 44 degrees. The General Advertiser, overlooked the controversy and found common ground. All doctors said the fever could be controlled, and "a brisk NORTH-WESTER sprung up." At Wednesday market Welsh heard the mayor's wife say the cold front "already had a wonderful effect" (The market itself was miserable, Welsh couldn't buy any butter.) On Thursday evening Welsh saw Dr. John Lynn who said "that in the course of the day, he was only called to one new patient, that he had conversed with several of the doctors, who signified that they had also very few fresh calls." Welsh told his boss that he could safely come to the Quaker's Yearly Meeting scheduled to begin that weekend as long as he took care not to "inhale the fumes of the contagion."
Oliver Wolcott took soundings from federal employees remaining in the city and wrote to the president on Friday the 20th that "the malady has within two days considerably abated and I have no doubt that each successive day will present still more favorable aspects." Wolcott informed government clerks who had fled to New York that they could return to their jobs. (The atmosphere in New York was not conducive to optimism. New York had a day of "fasting, humiliation and prayer" on Friday the 20th. "I never saw a more solemn day...," Mary Stockton, Rush's sister-in-law, wrote from the city. "The churches were all so crowded that numbers had to leave them for the impossibility of getting seats or even stands. We went to three before we could get in and then I had to stand the greater part of the time." There were many prayers for Rush.
The Treasury clerks didn't believe Wolcott's all clear, and begged to be excused longer. "We shall come from a fresh and pure air into a corrupt one, with all our fears about us," one clerk argued, and even quoted a poem: "He that fights and runs away/ May live to fight another day/ But he that is in battle slain/ Will never live to fight again."
Wolcott's good news proved premature. The epidemic regained its fury. It struck the seat of optimism, Rush's house on Walnut Street, again and again. Stall got the fever on the 18th; Fisher got it on the 20th. Two black nurses attended them. Coxe and Rush's sister also complained of feeling unwell. Only the black servant, Marcus, was able bodied.
"The shafts of death fly closer and closer to us every day," Rush wrote to his wife. "Stall is stationary after 5 bleedings. Fisher is so ill as to require a 3rd bleeding in the middle of the night. My sister is drooping. Coxe is better and does duty with a spirit that he never showed before. Marcus has not, like Briarius, a hundred hands, but he can turn his two hands to a hundred different things. He puts up powders, spreads blisters, and gives glysters equal to any apothecary in town." Unmentioned was Rush's own weakness. He could barely climb stairs, and had "a slow fever, attended with irregular chills and a troublesome cough," he later recalled, that "hung constantly upon me." Yet on the 20th he visited 25 patients, prescribed for 25 who came to his door and sent 38 to other doctors.
"Too weak to venture out," he wrote in his notebook on Saturday the 21st, "my low diet, my extreme labors, my sickness and the medicines I have taken to cure me have produced in me the weakness of a man of 80." He closed his Saturday letter to his wife looking to god for help: "I have thought that all good Christians should sit, eat, and even sleep with one hand constantly lifted up in a praying attitude to the Father of mercies to avert his judgments from us. O! that for his elect's sake he would cause the time of our sufferings to be shortened."
Even Marcus got the fever, as did other African Americans Rush had inspired to fight the epidemic. Rush treated Richard Allen and clung to the belief that blacks did not take the fever as badly as whites. Stall, who seemed almost beyond recovery, had become like a son to him. At breakfast a few days before, Rush told him that he did not forget him in his prayers, Stall replied sweetly, "Nor do I you, sir, in mine." That Sunday Rush learned that Stall did not take the medicines he prescribed for him, and "deceived all around him in his accounts of its operation."
The sickness in his house also humbled Rush. "In this afflicting situation I hope I have not sinned nor charged God foolishly," he wrote to Julia on Sunday night. He did not call on any patients that day, "owing to the extreme heat of the weather." He assured her he had "no complaint but weakness and a little sore mouth from mercury." In his notebook he revealed that he had ulcers in his throat and a "cough with copious expectoration." He blamed the ulcer on the disease, not calomel.
He still prescribed in his back parlor "for crowds of sick people." He found it more comfortable to sit cross legged like "the Arabians." He still had faith in his methods despite Stall's rejection of them, but he no longer bragged. He had many deaths to report, eight in families he knew, and he learned that 33 had been buried at Potter's Field that day before 3 p.m. He joked that the passage in the Episcopal funeral service was reversed, "In the midst of death, I am in life." That inspired a spasm of self-pity. "But O! by how tender a thread do I now hold it. I feel as if I were in a storm at sea in an open boat without helm or compass. My only hope and refuge thou knowest, O! God, is in thee!"
With his sister still doing poorly, though without signs of the fever, he feared that he would have to prepare his own bed at night. But his invalid mother rallied and did it for him. He went to bed but sleep was fitful. "I awoke in the night," he confided in his notebook, "and was kept awake for some time by the groans of Fisher in the next room to me, and by a noise in the room above me, which I supposed to be occasioned by the securing of Stall in his coffin, for I had given orders to have him buried in the night if he died." He dreamed that he had the yellow fever, covered with the red bumps "which are the immediate fore runners of death." His ears had deceived him. Stall had not died yet. The noise must have been the nurses restraining the patient or cleaning an explosion of vomit or blood.
Go to Chapter 8
There was a brisk trade in refugees. Stage companies still offered passage out of the city, but to get passage to Chester, for example, one had to buy a ticket for Baltimore. To get his housekeeper to Wilmington on Monday, Welsh found space on one of Levi Hollingsworth's shallops. Hollingsworth oversaw an extensive coasting trade, but had a devil of a time convincing captains that coming up to Philadelphia was perfectly safe as long as they stayed aboard their ships and didn't venture onto infected ground. Like many who remained in the city, Hollingsworth was loath to admit that the fever had full sway.
The mayor's committee made a point to remind the world that the city was not intrinsically unhealthy. It passed a resolution relieving the city of the onus that the report of the College of Physicians had put on it. Dock side filth did not cause the disease. The city was "much exposed... from the numbers that are daily arriving from foreign parts where infectious disorders are frequently prevalent...."
Of course the rest of the world was hellbent on preventing exposure to the Philadelphia fever. Before leaving Philadelphia, Secretary of War Knox wrote to the president that "the stroke is as heavy as if an army of enemies has possessed the city without plundering it." On the road,Knox met the armies. "The alarm of the people in all the towns and villages on the road to New York... is really inexpressible. The militia are passed at Trenton, Brunswick, Newark and New York." Only Elizabeth-town was hospitable and there Knox waited out a 14 day quarantine which would allow him to travel through New York.
That city had a specially appointed health committee to investigate all reports of sickness. All refugees from Philadelphia were taken to tents in an island in the harbor. A night patrol was formed to prevent secret landings. All people seekingpassage by boat into the city had to get the health committee's permission which they were chary of giving.
James Graham, a Philadelphia doctor then in New York, fumed in a letter home, that New Yorkers wouldn't mind placing guards "round Philadelphia armed with rifle guns and shooting down like black birds every affrighted citizen who would attempt to leave it." Graham laughed at a proposal "to smoke all" from Philadelphia. "I entertained some apprehension, least they should convert me into bacon before I could effect my escape."
Vigilance was as great south of Philadelphia. Treasury auditor Richard Harrison made the passage to Virginia before all the stages were stopped. Still in Alexandria even old friends avoided him. "The consternation (was) greater here than at Philadelphia," he wrote. "Camphor and preservatives are in use with many." No vessel from Philadelphia was allowed closer than a mile. The militia stopped carriages two miles outside of Baltimore. In one case passengers were forced out by armed men, one threatened to shoot Mathew Carey, a Philadelphia publisher, if he stepped "within his line." The passengers were forced to sleep outdoors and not fed until ten the next morning. Carey wrote home about his ordeal and a garbled account that appeared in a Philadelphia newspaper claimed that stranded passengers were offered "a piece of dry cheese on the end of a pitch-fork."
Rush did not ridicule sensible precautions taken by people outside the city. He told his wife that she should "converse with nobody now who comes from Philadelphia. Everything is infected in our city." For Rush, Monday was his first day of rest in almost a month. The community at large probably did not notice because Rush carried on his crusade in the newspapers. An anonymous paragraph echoed what he had written to his wife Sunday morning: "Some persons object to Dr. Rush's mode of treating the yellow fever because it is so simple - requiring only two remedies mercurial purges and bleeding. Such persons should recollect, that a stone and a sling in the hands of little David, brought Goliath to the ground.
In a signed article he suggested measures to keep one from becoming predisposed to the disease. Everyone exposed to the contagion should "live upon a milk and vegetable diet, and take cooling purges once or twice a week." Then the disease, if taken, would be mild. Rush did not spell out the medical rationale for the diet, because it was widely accepted that meat and spirits promoted putrefaction within the body. Nor did he have to explain how sunlight increased putrefaction. He had noticed houses with bedding hanging out the windows, so he cautioned that the bedding and clothes of the sick "should upon no account be exposed to the heat of the sun, but washed in warm, or soaked in cold water." He reiterated that the sick must "by no means... take vomits, bark, wine, or laudanum." He did approve "napkins dipped in pump water...applied frequently to the forehead."
Rush did not completely dominate the media. Responding to Hamilton's suggestion, Dr. Stevens wrote a long letter to the College of Physicians about his methods. To Rush's chagrin it was printed that Monday. Stevens did not mention Rush by name but he did ask "should not violent evacuations which evidently weaken and relax be avoided," given the "extreme debility inanimal functions and great derangement of the nervous system" occasioned by the disease.
Rush immediately complained to Dr. Redman, president of the college, that by printing Stevens' letter the college seemed to endorse his methods. Redman replied that since Hamilton had mentioned that Stevens would explain his methods to the college, it would have been "offensive to the public" to withhold what he wrote. Rush also wrote to the college as a whole complaining that Stevens' letter would "co-operate with Dr. Kuhn's plan... in adding to the mortality of the disorder." If he survived the epidemic Rush promised to prove Stevens wrong. Meanwhile, the explained that the debility Stevens treated was not a direct result of the disease but "arises wholly from an excess of the stimulus of contagion upon the system." The body was so overstimulated that it was collapsing. That stimulus had to be removed by purging and bleeding, which would reduce the disease "to a level with a common cold," provided patients could "be visited by physicians as often, and attended by nurses as carefully, as in other acute diseases." The letter was printed in the newspapers on Tuesday.
Strong enough to carry on the controversy, Rush could not have been that sick. However, away from the battlefield, he could at last reflect on the misery he had seen. "Many die without nurses," he told his wife. "Some perish from the want of a draught of water. Parents desert their children as soon as they are infected, and in every room you enter you see not a person but a solitary black man or woman near the sick. Many people thrust their parents into the streets as soon as they complain of a headache. Two such exiles have taken sanctuary for half a day in our kitchen and shop." He also reflected on his good works. "So great is the apprehension of death from the disorder that I have seldom visited a patient for the first time without being met at the head of the stairs by some member of the family in tears. Good Mrs. Mease took me by the hand the first time I visited her son and was dumb for some time with fear and distress. Another lady... fell upon my neck and wept aloud for several minutes before she would let me enter her husband's room. They were patients of Kuhn's. They proposed a consultation [with Kuhn], but I objected to it. I said I had a confidence in my remedies and that I must attend him alone or not at all. They consented to my proposal, and after three bleedings he recovered."
He couldn't help but notice that Kuhn and Stevens had left the city, "and Dr. Shippen is nobody knows where." Every other doctor who had gotten sick was still unable to see patients.Yet Rush mustered the strength to see people in his house on Tuesday, and even visit some nearby on Wednesday. "I am thankful for this great privilege," he wrote to Julia. "It is meat and drink to me to do my Master's will." Two ministers visited him as he convalesced. "Mr. Fleming called upon me this morning and informed me that he had found in visiting his congregation many people cured by following my printed directions without the advice of a physician. Mr. Helmuth called upon me soon afterwards and told me nearly the same thing." (Helmuth mentioned his visit in his journal: "Met Dr. Rush who is feeling well and confident. Felt bad myself. Lord, your will may be done!")
Rush did not worry about being unable to visit patients. Stall and Coxe, he wrote, "are doing wonders in our city. They visit and cure all my patients." In a letter he wrote to his parents on Sunday Stall marvelled at his suddenly becoming a doctor. "So many doctors are sick, the poor creatures are glad to get a doctor's servant." However not a few families were taken aback when a 19 year old came to treat their loved ones. They wrote to Rush, asking for his opinion and instructions. Throughout his career Rush saved letters from patients and he had no qualms about dispensing advice in letters. Unfortunately, save for some bare notes he wrote on a few letters, what he prescribed in most cases is not known. The letters do reveal how his patients suffered.
Dr. John Mease did not stint in following Rush's prescriptions. His father said he lost 4 1/2 pounds of blood in five days, and had 25 bowel movements resulting from purges. After that Mease's father wrote to Rush wondering if it was time to begin stimulating the patient with "nourishing drinks." What alarmed him was the twitching and starting as his son drifted in and out of sleep.
Alexander Cochran gave the best description of mercury poisoning. The purges were violent, working "pretty severely up and down." The side effects were daunting: "My lips and gums have been much swelled, and the skin excoriated these several days past. In consequence whereof I have spat blood these three nights past, but particularly last night from a half a pint upward." He asked for something to stop his bleeding mouth. If it was not "alarming," it was still "weakening and very disagreeable." Cochran did not submit to bleeding very well. After losing 6 ounces he "nearly swooned away."
In the case of the ten year old son of the prominent merchant Mordecai Lewis, "liquids color'd with blood" continually "rose out of his mouth while sleeping." Rush had some inkling of the problem. After taking his purges he confessed it made his mouth sore. When he began making his rounds again on Thursday, the Lewis boy was one of the first he saw. Rush's apprentice Fisher had bled him and the incision would not stop bleeding. When Rush saw the boy, he changed treatment, using medicines that were anathema in his published statements: laudanum and bark in glysters. To no avail. The glysters would not stay. The father tried to get the medicine down his son's throat but that seemed to strangle him. That night the boy "vomited up a large worm, 8 or 9 inches long and full thick as a quill," and died shortly afterward.
The power of the fever was such that few blamed Rush for deaths, and many lauded his remedies when they preserved a seemingly sick person from having the most fearful symptoms.William Sansom was "reduced extremely low by physick and bleeding," but he didn't have black vomit, and he recovered. So when Richard Wells got a fever, Rush was immediately sent for.
That call on Wednesday morning probably inspired Rush to cut short his own convalescence. Rush's quick, authoritative treatment of his uncle impressed Benjamin Smith. Wells seemed to have a "light" fever, yet "the doctor took every precaution, the first appearances not having always proved a sure presage of its progress - he has been repeatedly bled and has taken freely of the mercurial powders which seem to have operated kindly and... with good effect; his fever is much reduced tho' not quite removed & he spent last night as easy as could be expected when under the operation of his physic." (A week later, Smith found Wells "much reduced under Dr. Rush's mode of treating the disorder.")
By treating patients decisively at the first sign of fever, Rush left himself vulnerable to the charge that it was not really yellow fever he was curing. With Kuhn and Stevens out of town, William Currie took up the dispute with Rush. In an article Tuesday the 17th he recognized that there were "above a thousand ill," but very few had true yellow fever. Rush's treatments worked because most had complex symptoms arising when the "common remittent or fall fever" attacked a person "not fully recovered from the affects of the influenza." In such cases there was "a violent determination of blood to the head, accompanied with acute pain, a redness of the eyes, with a faint tinge of yellow - the pulse is quick and the skin hot." True yellow fever, Currie urged, should be treated by Kuhn's and Stevens' methods. Rush's methods would "bring certain death." Fortunately there were only "40 to 50" yellow fever cases in the city. And the disease was easily avoided by paying "proper attention to fumigating and ventilating the houses, clothing and utensils" used by the sick. If that were done, Currie concluded as he strained to match the always upbeat Rush, "the infection which has proved so mortal, will most certainly be eradicated in a few days.... It is time the veil should be withdrawn from your eyes, my fellow citizens!"
Currie's attack sent Timothy Pickering rushing to Rush's house, where he found young Dr. Physick there discussing autopsies he had witnessed at Bush Hill. Physick had seen marked stomach inflammation and was convinced Rush was right, purging and bleeding were necessary. Physick offered to write something in support of Rush. While pleased at the young man's enthusiasm (he had been a student of Kuhn's,) Rush cautioned him not to mention the inflammation of the stomach because that would "deter others from the use of calomel." The "theory" behind the treatment, Rush explained, had best "be settled hereafter." The next day Physick's letter was in the newspaper endorsing Rush's method against "the most powerful of the inflammatory diseases."
There was a well orchestrated defense of Rush's methods in the newspapers. Rush began it with a letter, written in the third person, which reiterated Sydenham's stricture that "no two epidemics of unequal force can still exist long together in the same place." Rush assured the public "that all the fevers now in the city are from one cause, and that they all require different portions of the same remedies." The fever he had just recovered from must have been the yellow fever since he had been exposed to it for three weeks. Yet he recovered after "two copious bleedings, and two doses of the mercurial medicine, and that too, in the short time of only two days."
Following that there were paragraphs announcing the recovery of Dr. Penington "after five bleedings, and the liberal use of the mercurial powder." Dr. Mease had used the same remedies and was out of danger. An Observer wrote that while not grounded in theory, Rush's cure had "nothing to recommend it at present but its wonderful success." Doctors said his dose "would kill a horse." Observer knew "it has not killed a weakly infirm lady.... On the contrary it has restored her to health and may not the same be said of hundreds who have submitted to his prescriptions." As for the West Indian method, "we are tired with numbering those it has already laid in the dust."
On Saturday the 21st "T.P." (Pickering) weighed in noting the cures in his family and the deaths of neighbors "under other modes of treating the disease." He ridiculed Currie for claiming that Rush's medicines cured the common fever but not the yellow fever. If 1,040 are sick and 1,000 have the common fever which Rush's methods cure, "Fly then, my fellow citizens, from other methods, which have brought so many to untimely graves."
That support did not sooth Rush. As a gadfly reformer trying to cure a wide range of society's ills Rush was used to being applauded and then seeing his prescriptions ignored. But hec ould not tolerate having his expertise challenged in such a crisis. In the best of times Rush saw conspiracies against the forces of good whether his cause be reforming government, religion, education or medicine. This was the worst of times and he could save hundreds who died in agony. His anguish seethed into almost paralyzing paranoia. In a letter to his wife, he claimed that his colleagues had "confederated against me in every part of the city. Dr. Currie (my old friend) is now the weak instrument of their malice and prejudices. If I outlive the present calamity, I know not when I shall be safe from their persecutions. Never did I before witness such a mass of ignorance and wickedness as our profession has exhibited in the course of the present calamity. I almost wish to renounce the name of physician. Even the nod of Dr. Kuhn in his lurking hole at Bethlehem [Pennsylvania] commands more respect and credit from my brethren than nearly 1,000 persons in different parts of the city who ascribe their lives to the new remedies. Our neighbor Davidson died yesterday under the use of bark, laudanum, and the cold bath administered by the hands of Dr. Currie. Indeed the principal mortality of the disease now is from the doctors."
Rush's campaign suffered a set back when Dr. Penington died. Rush saw him that day "shattered by delirium." He wrote a short note for the press explaining that "in consequence of going out too soon after his recovery, [Penington] relapsed a few days ago and is since dead." The death of another doctor caused no shock waves, in part because the weather changed. It was cold Wednesday morning, 44 degrees. The General Advertiser, overlooked the controversy and found common ground. All doctors said the fever could be controlled, and "a brisk NORTH-WESTER sprung up." At Wednesday market Welsh heard the mayor's wife say the cold front "already had a wonderful effect" (The market itself was miserable, Welsh couldn't buy any butter.) On Thursday evening Welsh saw Dr. John Lynn who said "that in the course of the day, he was only called to one new patient, that he had conversed with several of the doctors, who signified that they had also very few fresh calls." Welsh told his boss that he could safely come to the Quaker's Yearly Meeting scheduled to begin that weekend as long as he took care not to "inhale the fumes of the contagion."
Oliver Wolcott took soundings from federal employees remaining in the city and wrote to the president on Friday the 20th that "the malady has within two days considerably abated and I have no doubt that each successive day will present still more favorable aspects." Wolcott informed government clerks who had fled to New York that they could return to their jobs. (The atmosphere in New York was not conducive to optimism. New York had a day of "fasting, humiliation and prayer" on Friday the 20th. "I never saw a more solemn day...," Mary Stockton, Rush's sister-in-law, wrote from the city. "The churches were all so crowded that numbers had to leave them for the impossibility of getting seats or even stands. We went to three before we could get in and then I had to stand the greater part of the time." There were many prayers for Rush.
The Treasury clerks didn't believe Wolcott's all clear, and begged to be excused longer. "We shall come from a fresh and pure air into a corrupt one, with all our fears about us," one clerk argued, and even quoted a poem: "He that fights and runs away/ May live to fight another day/ But he that is in battle slain/ Will never live to fight again."
Wolcott's good news proved premature. The epidemic regained its fury. It struck the seat of optimism, Rush's house on Walnut Street, again and again. Stall got the fever on the 18th; Fisher got it on the 20th. Two black nurses attended them. Coxe and Rush's sister also complained of feeling unwell. Only the black servant, Marcus, was able bodied.
"The shafts of death fly closer and closer to us every day," Rush wrote to his wife. "Stall is stationary after 5 bleedings. Fisher is so ill as to require a 3rd bleeding in the middle of the night. My sister is drooping. Coxe is better and does duty with a spirit that he never showed before. Marcus has not, like Briarius, a hundred hands, but he can turn his two hands to a hundred different things. He puts up powders, spreads blisters, and gives glysters equal to any apothecary in town." Unmentioned was Rush's own weakness. He could barely climb stairs, and had "a slow fever, attended with irregular chills and a troublesome cough," he later recalled, that "hung constantly upon me." Yet on the 20th he visited 25 patients, prescribed for 25 who came to his door and sent 38 to other doctors.
"Too weak to venture out," he wrote in his notebook on Saturday the 21st, "my low diet, my extreme labors, my sickness and the medicines I have taken to cure me have produced in me the weakness of a man of 80." He closed his Saturday letter to his wife looking to god for help: "I have thought that all good Christians should sit, eat, and even sleep with one hand constantly lifted up in a praying attitude to the Father of mercies to avert his judgments from us. O! that for his elect's sake he would cause the time of our sufferings to be shortened."
Even Marcus got the fever, as did other African Americans Rush had inspired to fight the epidemic. Rush treated Richard Allen and clung to the belief that blacks did not take the fever as badly as whites. Stall, who seemed almost beyond recovery, had become like a son to him. At breakfast a few days before, Rush told him that he did not forget him in his prayers, Stall replied sweetly, "Nor do I you, sir, in mine." That Sunday Rush learned that Stall did not take the medicines he prescribed for him, and "deceived all around him in his accounts of its operation."
The sickness in his house also humbled Rush. "In this afflicting situation I hope I have not sinned nor charged God foolishly," he wrote to Julia on Sunday night. He did not call on any patients that day, "owing to the extreme heat of the weather." He assured her he had "no complaint but weakness and a little sore mouth from mercury." In his notebook he revealed that he had ulcers in his throat and a "cough with copious expectoration." He blamed the ulcer on the disease, not calomel.
He still prescribed in his back parlor "for crowds of sick people." He found it more comfortable to sit cross legged like "the Arabians." He still had faith in his methods despite Stall's rejection of them, but he no longer bragged. He had many deaths to report, eight in families he knew, and he learned that 33 had been buried at Potter's Field that day before 3 p.m. He joked that the passage in the Episcopal funeral service was reversed, "In the midst of death, I am in life." That inspired a spasm of self-pity. "But O! by how tender a thread do I now hold it. I feel as if I were in a storm at sea in an open boat without helm or compass. My only hope and refuge thou knowest, O! God, is in thee!"
With his sister still doing poorly, though without signs of the fever, he feared that he would have to prepare his own bed at night. But his invalid mother rallied and did it for him. He went to bed but sleep was fitful. "I awoke in the night," he confided in his notebook, "and was kept awake for some time by the groans of Fisher in the next room to me, and by a noise in the room above me, which I supposed to be occasioned by the securing of Stall in his coffin, for I had given orders to have him buried in the night if he died." He dreamed that he had the yellow fever, covered with the red bumps "which are the immediate fore runners of death." His ears had deceived him. Stall had not died yet. The noise must have been the nurses restraining the patient or cleaning an explosion of vomit or blood.
Go to Chapter 8
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