Rush must have worn his exhaustion well.Only his old friend, John Adams, writing to his wife in mid-January, mentioned how tired he looked. But at that point it's not certain if his exhaustion could be attributed to the epidemic or to his continuing labors: newspaper controversy over the origin the epidemic, his medical school lectures in which he sought to destroy Kuhn, and his monumental memoir of the epidemic. In addition he and his family moved into a house at 98 South Fourth Street, just south of Walnut Street. And he continued to see patients and was fascinated how, just as Sydenham had shown over a century before, diseases coming after an epidemic took on many symptoms of that epidemic disease. The "constitution of the atmosphere," some as yet undiscovered quality of the air, made all diseases since September 10 inflammatory. Ironically, given the religious passion so evident in his letters during the epidemic, the one exertion Rush avoided was participating in the emotional debate over the effort to prevent a return of the epidemic by closing the theaters.
Rush was not the first to try to put the epidemic in perspective. Mathew Carey, one of the nation's leading publishers and book sellers, appreciated the value of getting a history of the ordeal in bookstores as soon as possible. On November 14 he published a 97 page tour de force describing the epidemic during which 4,044 people died (no one hazarded a guess as to how many died from yellow fever but in 1792, 1165 died of all causes in 12 months.) Margaret Morris sent it to friends and endorsed it as "a pretty good account of the late occurrences in our city." With four printings in three months and with each new edition including more names of those who died, Carey sold 10,000 copies.
In his introduction, Carey described the boom times of the city, replete with high rents and "alarming" luxury, and allowed that few "will pretend to deny that something was wanting to humble the pride of a city, which was running in full career, to the goal of prodigality and dissipation." That said, the rest of the book was a cordial to the city's reputable citizens. "Tipplers and drunkards," "fille de joie," and the poor especially suffered during the epidemic. Those in "dirty houses have severely expiated their neglect of cleanliness and decency...." He did criticize the general panic: "The old custom of shaking hands fell into such general disuse, that many were affronted at even the offer of the hand.... And many valued themselves highly on the skill and address with which they got to windward of every person they met." But in his discussions of the abandonment of the sick, he generalized. He specified acts of charity and honored heroes like Clarkson and Girard by name. Carey served on the Committee, save for the three weeks he was out of town on a trip to Virginia. He lauded his colleagues. He absolved those who fled the city from the charge of cowardice. By leaving they made the city safer for those who remained. There was more food available in the markets and less opportunity for contagion to take hold. "Although the proceedings of many people in Philadelphia have been strongly tinctured with cruelty, and a total dereliction of every principle of humanity," he concluded, "yet the general conduct has not been so revolting as in London during the plague."
The behavior of other cities earned sterner scrutiny - 22 pages of the 97 page text chronicled their insensitivity and the cruelty of their quarantines. As he wrote in mid-November, lies were still being spread impugning the health of the city in an effort to effect the city's "entire destruction." While he congratulated most segments of the Philadelphia community, Carey did take two swipes which, fortunately for a fuller picture of the epidemic, would elicit pamphlets in response. He thought church services had spread the disease and noted the great mortality in one of the most active congregations, Helmuth's German Lutheran Church, where 641 people were buried. Helmuth replied with a moving memoir of his sacrifices and noted that when other churches turned corpses away from their burial grounds, his buried all brought to its gate.
Prior to publication of his book, Carey had written a shorter history published in newspapers in mid-October. In that he had briefly mentioned the abandonment of patients in a way that might suggest that the black nurses were part of the hell, not the salvation of the city. Families "resigned" sick members "to the care of perhaps a single negro." Jones and Allen asked Rush to correct Carey's slight. He obliged and wrote to Carey describing the sacrifices of Allen, Jones and their associate William Grey in procuring nurses and burying the dead. "Many of the black nurses," Rush added, "it is true were ignorant, and some of them were negligent, but many of them did their duty to the sick with a degree of patience and tenderness that did them great credit." That blacks were not "exempted from the disorder" enhanced the merit of their service.
In his book Carey lauded the African American leaders, saying their services demanded "public gratitude," but he added that the great demand for nurses was "eagerly seized by some of the vilest of the blacks" to extort up to $5 a night for attending patients, and "some of them were even detected in plundering the houses of the sick." Plus "a hardened villain from a neighboring state formed a plot with some negroes to plunder houses." They were "seized and the company dissolved."
In reply Jones and Allen published a pamphlet that pointed out cases of extortion, robbery and cruelty by whites. They chronicled the sacrifices of blacks, including a strict accounting of the money spent by the Free African Society, and the disposition of all the beds the society was asked to bury temporarily as a means of disinfection. They told the nurses' side of the story. They were lured by ever spiraling wages, and still many served for next to nothing. What they had to put up with was almost insupportable at any wage. Many patients were "raging and frightful to behold; it has frequently required two persons to hold them from running away, others have made attempts to jump out of a window, in many chambers they were nailed down, and the door was kept locked, to prevent them from running away, or breaking their necks, others lay vomiting blood, and screaming enough to chill them with horror. Thus were many of the nurses circumstanced, alone, until the patient died, then called away to another scene of distress and... many of them having some of their dearest connections sick at the time, and suffering from want, while their husband, wife, father, mother, & c. have been engaged in the service of the white people."
Rush was not numbered among Carey's heroes and was mentioned solely as the author of the rotting coffee theory for the genesis of the disease. Carey disagreed and blamed the privateer Sans Culottes and her prize the Flora. The privateer's "filth was emptied at a wharf between Arch and Race Streets," and dead bodies were seen taken off the ships. Otherwise, medically speaking, "the whole of disorder, from its first appearance to its final close, has set human wisdom and calculation at defiance."
Perhaps it was Julia's return that calmed Rush down so that he did not immediately attack Carey with his customary acrimony. More likely, Rush understood that with the end of the epidemic, he could not justify hastily conceived pronouncements and attacks as necessary to save people from sickness and death. It was time to reassume his role as professor, and be sure that his proofs were sound and convincing. Others were quick to write to the newspapers attacking Carey on the issue, (and given the tenor of their rebuttals some evidently without Rush's coaching.)
James Vanuxem, who owned the Flora, asserted that no one on her nor on the Sans Culottes had been sick. The ships had come from Britain and France respectively, not the West Indies. It was true that a body had been removed from the Flora on July 27, but that Frenchman had been boarding on Water Street, where he got the fever. After being kicked out of his boarding house, he had come to Vanuxem's wharf, and was placed on the Flora's deck where he died in the night. Drs. Currie and Cathrall countered Vanuxem's letter with proof that the fever came from the Sans Culottes, Flora, or the Amelia. Every crewman of the Amelia, which came from Haiti, arrived sick; and Dr. Cathrall had treated one of the crew from the Sans Culottes, which had captured several other ships who had crew members with yellow fever. The doctors demonstrated how Mrs. Parkinson, Cathrall's first fever patient who died August 6, could have gotten the disease from a sick Frenchman. The evidence was conclusive: just as in 1762, the epidemic had come from the West Indies.
Rush's opponents soon introduced innuendo into the debate. "That the late mortal sickness was imported is now so generally known," a correspondent wrote, "that it requires more faith to believe the contrary supposition, than is perhaps required to move mountains." Of course, Rush's friends replied in kind. One noted that the Amelia was the ship that brought the damaged coffee which caused the disease once it rotted on the wharf. Those who believed otherwise were like "some Genoese seamen" who blamed the plague on "a ball of fire, which either burst out of the earth, or fell down from the heavens." Dr. James Mease pointed out that every seaman who got the fever had been exposed to the rotting coffee. Plus it was insulting to the late port physician, Hutchinson, to think that he would have let any sick seamen or passengers get into the port. Another writer reminded that Rush first recognized the epidemic and developed the best treatment, so it was best to wait for his promised proof for the local origins of the disease.
At the end of October the governor had asked the College of Physicians what caused the epidemic and how to prevent another. In mid-November the College, from which Rush had resigned, endorsed the importation theory. There was no evidence that yellow fever had ever been generated in the city or state, "but there have been frequent instances of its having been imported." They thought it had come to the city in some vessels after the middle of July. Quarantines could prevent future epidemics. Three members, Redman, Foulke and Leib, did not sign the letter. Evidence was too sketchy and they didn't want to insult Rush. Friends of Rush were quick to ridicule William Shippen who signed after spending the entire epidemic outside the city.
In the next century as the philosophy of free trade informed the effort to end restrictions on shipping, doctors who offered proofs for the local origin of contagious and potentially epidemic diseases, including yellow fever, became the darlings of liberal society. Quarantine seemed a most primitive form of commercial restriction. But Rush had expressed no interest in the principle of free trade. In 1793 the major worry of most Philadelphians was property values.
"In the name of everything good," implored an anonymous writer to Rush, "what can induce you to act so much the enemy of this place? Will it alter the nature of things, or be of the least advantage to mankind to know from whence it did arise, other than importation? Will not the New Yorkers, the Baltimoreans, and all other enemies of this town rejoice...?" Upon publication of his theory "all real property would fall in a little while 20 or more percent.... Let it not be said, we have the greatest of our enemies in our own city. Think O Think Seriously."
Samuel Meredith urged him not to publish his theory. Three friends, Bishop William White, William Lewis and Peter Baynton, thought he should publish. Tench Coxe, a Treasury official and land speculator, begged him to at least delay his pamphlet until after Congress convened. Rush had never stinted in his efforts to promote Philadelphia. He well knew as he developed his "proofs" that they did not particularly indict Philadelphia, but he wisely held fire until the city was truly back to normal, after the President moved back on November 30 and Congress convened on December 2. Rush knew how wary many politicians were, and did his might to convince them to come. On November 19 he assured the worried clerk of the House, John Beckley, that "a greater degree of health had never prevailed in this city than at present."
Congressmen came, many with trepidation. Maryland representative William Vans Murray's family was "in an uproar" at the idea of his staying in the city during the winter, and he was inclined to expect "short and irregular resurrections of the fever." But once in the city, new arrivals were quickly calmed. "It is surprising how soon a person wears off those impressions of terror, which tho' all alive when he first enters the city, are forgotten in the course of a few hours," Thomas Adams, a young lawyer and son of the vice president, wrote. "The idea of danger is dissipated in a moment when we perceive thousands walking in perfect security about their customary business."
Vice President Adams and the group of congressmen coming south with him thought it prudent to pause in Trenton to receive fresh assurances about the safety of the city, which they received. They came in and soon were partaking in the gossip that defanged the epidemic: Dr. Hutchinson was the "victim of his own French zeal," by letting in "infected persons and goods from French vessels." The "greatest mortality" was in "bad houses and among loose women and their gallants among the sailors and low foreigners." Fisher Ames, a congressman from Massachusetts, virtually closed his ears to talk about the epidemic because "many facts are lost; and faction among the doctors, and grief and terror among the citizens, have distorted those which are to be collected." As far as he could tell, the only man to have had the "decided malignant symptoms" of the disease and survive was his party's leader Alexander Hamilton. Unfortunately the method used to cure him had been "condemned by the Rushites" and never fully tested. A blanket of snow on December 4 calmed everyone.
Rush presented his proofs in a long letter to Dr. Redman, written on December 7 and published the 11th. Rush went back to basics. Yellow fever was endemic to the West Indies where, all authorities agreed, it was produced by "vegetable putrefaction." Since "the same causes (under like circumstances) must always produce the same effect," and since Philadelphia's summer had been of tropical intensity, putrefying vegetables near Water Street could have engendered a disease of tropical intensity. Instead of the typical bilious fevers, conditions produced a higher grade of bilious fever. So far all Rush had said did not have to be proved. Even though smallpox, measles, rabies and syphilis were recognized as specific diseases that could be spread in unique ways, that did not challenge the age old belief that most fevers manifested themselves according to the degree of deleterious environmental stimulus.
Undoubtedly the variability of symptoms in malarial fevers and their similarity to symptoms in dysentery, typhus, typhoid, yellow fever and dengue fever defeated any attempts to theorize that each type of fever was caused by distinct pathogens. To prove his point Rush only had to show that fevers of the same intensity as that in Philadelphia were found that sickly season in other parts of the country where ships from the West Indies didn't land and refugees from Philadelphia didn't flee. Rush's proof was in the letters he got from around the country. An old student in Caroline County, Maryland, saw fevers there more "obstinate and inflammatory" than usual, with head pains and black and yellow vomit, including a man "in a laughing delirium," who "died in about five minutes laughing to the last." A correspondent in Dover, Delaware, wrote of an epidemic of "bilious colic... unprecedented in the medical records or popular traditions of this country." A doctor in Connecticut thought 33 fevers in Wethersfield near Hartford were "analogous" to the fevers in Philadelphia.
Philadelphia's contagion was most deadly because of the greater concentration of putrefaction along the docks. The rotting coffee increased that to a level which allowed the deadly epidemic to begin, and the disease spread just as the stench of the rotting coffee was blown down streets and alleys. The annals of medicine were filled with analogous situations. Putrefied potatoes killed 14 in Tortola, West Indies, "vast quantities of cabbage thrown in a heap" killed many in Oxford, England. Rush dismissed the recently published arguments of two French doctors, Nassy and Robert, that blamed diet and greasy, dirty skin obstructing perspiration, for causing the disease. "Without the matrix of putrid vegetable matters," Rush insisted, "there can no more be a bilious, or yellow fever generated amongst us, than there can be vegetables without earth, water, or air."
Rush did not deny that in rare cases, as in 1762, an epidemic could begin from yellow fever brought to the port by a sick sailor from the West Indies. But isolated yellow fever cases were common every year in Philadelphia, produced by "active but limited miasmata." Rush argued that establishing that fact did not harm the city. "While the cause of a malignant fever is obvious to the senses, it will be easy to guard against." To deny the senses and the dictates of conscience would hazard "the lives of millions that are yet unborn." He recalled the campaign he led to cover Dock Creek which when done added much to the health of the city. Far better than exciting the fear that any ship from the West Indies could desolate the city would be to know that the city was safe as long as it was kept clean.
Meanwhile Rush battled for his theories in another arena. He used the occasion of his medical school lectures beginning the first week in December to describe his triumph over the fever and his colleagues. Over 52 years later, one of his students, Charles Caldwell, recalled Rush's first lecture as "a performance of deep and touching interest, and never... to be forgotten." Rush described the "terrible sweep" of the pestilence, his dejection at the failure of his cures, the joy of finding a successful remedy, and his persecution by the College of Physicians. Caldwell remembered that Rush had been "sufficiently sarcastic and trenchant" in ridiculing his enemies.
Along with his lectures on the "institutes," or basic principles of medicine, he lectured December 9 on "the character of Dr. Sydenham." He drew parallels between Sydenham's response to the 1665 plague and his own performance during the epidemic. Sydenham had treated patients depending on the climate, change in weather and the state of "morbid action in the system." Sydenham was accused of murdering people by blood letting and large doses of bark. He gave the fever no quarter. Rush cheered him on: "Most of his medicines are artificial, and his practice, in most diseases, is a war against nature."
Kuhn did not shrink from discussing the epidemic in his lectures, and tried in vain to deflect the applause for Rush with a brand of cynicism that usually appealed to students. He too had known the military surgeon Dr. Young, whom Rush credited with first using drastic purges. Kuhn recalled that he was "an eccentric character, and particularly so in medicine." Young was recovering from a serious illness when he insisted on taking 10 grains of calomel combined with 10 grains of rhubarb, "to carry off, according to his idea, the bile which he supposed to be the cause of the disease. The medicine however carried him off and at that time, at least, no person thought of imitating his practice." Kuhn insisted that mortality was greatest among those profusely bled and purged.
This time the fight between Rush and Kuhn did not spill out into newspapers. Even the fight over importation or local origin of the disease received little more coverage. The public controversy of the moment was the campaign to keep theaters closed. As the epidemic waned there were indications that those who had been preaching divine judgment would not be content to merely hosanna thanksgiving. On November 8, "An Earnest Call Occasioned by the AlarmingPestilential Contagion," did not mince matters: "The wrath of the Almighty seems inflamed against this city - his wrath impregnated with death!... I know there are many who attribute this awful contagion to natural causes, and ridicule the idea of a supernatural agent: but I conceive we may clearly trace the finger of God in our chastisement." The tract called for a stop to profanity, Sabbath breaking and lack of family prayers.
Most people did not respond to the lesson. When he returned to the city, Quaker James Bringhurst was appalled at how people went about their business as if nothing had happened. He began to "fear something yet more dreadful" to humiliate "this wicked proud people, many of whom look as if they scarcely thought the ground good enough for them to walk upon." On November 14 the governor set aside December 12 as a state wide day of "humiliation, thanksgiving and prayer." Such days were always problematical in Philadelphia because Quakers refused to participate in state sanctioned religious events, but they took the lead in pushing the city toward atonement. On December 2, they sent a petition to the state legislature calling for stronger laws against vice and immorality, especially the theater, which introduced "infidelity, profligacy and licentiousness." They asked the legislature to outlaw theatrical entertainments in the state. It was the only way to placate God given the "superficial impression" made on many people by "the deeply humbling dispensation lately experienced in this city."
American state governments had long passed laws for the "suppression of vice and immorality." In Delaware, theatrical entertainments were still outlawed and in October, the legislature had admonished citizens not to attend a musical entertainment "with tragical scenes" at a time when "the judgments of the Lord are manifestly surrounding us." Most regulations were crafted so they came up for periodic review before the legislature, which, Governor Mifflin noted in his December 5 address opening the legislature, was the case in Pennsylvania. The legislature flattered Quakers by letting members of the society read the petition, then it was sent to committee.
At first newspapers did not take the petition seriously beyond comparing Quakers to Spanish inquisitors. But the Quaker petition struck a chord that would resonate from pulpits on the day of thanksgiving. John Adams heard Rev. Ashbel Green, a Presbyterian, preach "judgment as well as mercy and told his hearers of all their faults. He went through the Decalogue and enumerated the transgressions of every article in it in this city." The arguments Henry Helmuth made in his soon-to-be-published memoir resounded from his and other pulpits. He recalled the throngs who went to Rickett's Circus. Then "after such a merry, sinful summer, by the just judgment of God, a most mournful autumn followed." The dying poor were brought to the vacated circus and the place once filled with "clappings of levity, was now filled with the lamentations and groans of the dying." God was trying to teach the city a lesson. All who lived through "days of death and terror" must fight to close the theaters. This was the very autumn the New Theatre, "one of the largest houses upon the continent for theatrical exhibitions," was to open, instead God caused the actors to flee the city in terror.
Part of the cogency of the argument arose because the doctors had no satisfying answers. An anti-theater "dialogue" in the newspapers used that to good effect. "A" asked "B" what the "natural or physical causes" of the epidemic were. "It is not yet ascertained, and perhaps never will be." As for the "moral" cause, it was "sin unrepented of, no doubt." The best way to prevent another epidemic was to "let the legislature enact suitable laws for the suppression of vice and immorality." On December 19, clergymen of all the major congregations sent a petition to the legislature calling for strong laws against Sabbath breaking, swearing, tippling houses, "places of gaming and lewd resort," and "theatrical exhibitions of every sort." Such reforms were imperative given "the solemn intimations of divine Providence in the late distressing calamity." They appended a 12 page pamphlet against theaters.
With the attack widened, friends of the theater had to do more than ridicule Quakers. "Plain Truth" argued that outlawing the theater would be unconstitutional, but not on first amendment grounds. Banning theaters would violate section 10 article 1 which states that a state cannot pass any "ex post factor law, or law impairing the obligation of contracts." Subscribers to the New Theater petitioned the legislature noting that the theater was built under the existing laws of the state, those building it incurred heavy debts so any law closing it "would be partial, retrospective and oppressive, and therefore unconstitutional." On February 5 the committee to which the anti-theater petitions were referred reported its recommendations for changes in the laws suppressing vice and immorality. There was no mention of theaters. The New Theater opened to acclaim, attracted crowds, and fueled a lively social season. John Adams wrote to his wife that parties were "more dissipated than last winter." The only concession to the epidemic was that many people rented rooms in the country for the coming summer so that there was "not a room to be let within 10 miles." Of the people in society, Adams thought only Mrs. Powel still seemed stricken.
The legislature did react to the epidemic. John Swanwick, a Philadelphia member, wrote a public letter to Rush asking him if he agreed that burials within the city should be outlawed to free the city from an obvious source of contagion. (It's possible this was to pressure churches, that profited from selling well located burial plots, to stop attacking the theater.) In his reply Rush gave priority to other reforms. Expanding the city limits to include Southwark and the Northern Liberties would give the corporation power to remove "offensive masses of matter which are suffered to putrefy" there. The docks and wharves should be cleaned and all "offal matters... carefully removed from gardens, yards, and cellars." During dry weather the streets should be washed with the fire engines until water could be brought in for that purpose from the soon to be completed Delaware and Schuylkill canal (a project on which work had been continuing that summer.) Trees should be planted to "absorb impure air," exhale fresh air and cool the city with shade.
By the middle of December the city's power structure was back in place and a grand jury was appointed to investigate efforts to purify the city. It reported on the 21st that there was "no cause for uneasiness or complaint." It suggested several reforms including Rush's ideas of planting trees and watering the streets. It also wanted a marine hospital south of the city to hold people in quarantine with a nearby "pest house" for victims of any future epidemic.
In the state legislature Swanwick called for special committees to draw up laws for both a board of health to supervise keeping the city clean and a harbor master to more rigorously enforce quarantines. But the legislature was slow to act. In late January the governor complained that there were reports of fevers in the West Indies yet he had no power to take preventive action as the law passed in September had expired. Even the city government seemed slow to act. For awhile many remarked on the cleanliness of the city then it became apparent that it arose from there being so little business for three months. Several newspaper correspondents complained about dirty streets and mounds of dirt left behind when they were supposedly cleaned. These worries were exacerbated by claims that the fever had returned, first in January and then just as the Committee met to give its final report in March which included a compendium of the names of those treated at Bush Hill noting those who died there and those who were "cured."
The supposed new cases did not impress the College of Physicians. It announced that there were no new cases. However, Rush was no longer a member of the college. In January Rush began seeing the symptoms of yellow fever, "particularly puking of bile, dark-colored stools, and a yellow eye." Dr. Griffitts told him of a patient with yellow skin. In February he bled John Coxe who had pneumonia and found his blood "dissolved" like the blood of yellow fever victims. Rather than raise an alarm, he merely pointed out to students that Sydenham taught that just such a similarity of symptoms in diseases succeeding an epidemic should occur. Rush however did not give any calming reports. Alarms, he thought, inspired the citizens to clean-up the city, which was all for the good. In addition he could not spare the time for controversy because he thought it essential that his memoir of the epidemic be ready before the summer when yellow fever might rage once again.
In February William Currie's account of the epidemic was published. While he endorsed blood letting and purging as the best way to treat the fever, he concluded that the fever spread through "specific contagion" like smal pox or typhus, not, as Rush insisted, through mephitic air. The fever did not spread to people outside the city because air deprived of oxygen was necessary for the spread of the contagion. But to say the stench from rotting coffee caused the disease was unwarranted. The seeds of the fever had to have come by ship from a place where the fever was endemic, the West Indies. Quarantine was the only way to protect the city from future epidemics. If the fever reached the city, then authorities should ferret out infected families, sending family member who are sick to a special hospital and family members who are sound to houses outside of town, while their house in the city was thoroughly disinfected.
Currie did not recount his activities during the epidemic, no mention of Hutchinson's death or his own illness. He wrote a medical monograph, and its influence was limited. Rush's memoir was five times the length of Currie's. With its blend of medicine and personal heroism, Rush's Account of the Bilious Remitting Yellow Fever as it Appeared in Philadelphia in the Year 1793 molded the next generation of American doctors and won a wide general audience.
He even did a better job than Carey in showing how the epidemic affected individuals. Rush discussed Hutchinson's obstinacy, Samuel Powel's dying smile, and quoted personal letters that documented Mrs. William Smith's profound depression. He detailed the terrors of the disease. Joseph Coates bled from his left eye. A patient of Dr. Woodhouse bled from her pierced ear. Dr. Fisher forgot everything that happened during his six days of fever. The disease "counterfeited nearly all the acute and chronic forms of disease to which the human body is subject." He brought order to the diversity of symptoms. It affected patients in three different ways. In some it produced coma, languor, sighing, yawning and a weak pulse; in others, pains, delirium, vomiting, heat, thirst, quick pulse with remissions in the fever; in many "the contagion acted so feebly as not to confine them to their beds or houses."
When discussing medical matters Rush did not parade his knowledge of nosology and Latin phrases, as Currie was prone to do. A master at the use of analogy, he cut medicine down to understandable size. Systems that multiplied the number of diseases were "as repugnant to truth in medicine, as polytheism is to truth in religion." Yellow fever was simply the highest grade of the fevers "derived from marsh miasmata." Noxious effluvia from rotting vegetable matter, coffee in this case, put the "seeds" of the fever in the body. In some that was enough to cause the disease within a few days. But in 99 cases out of 100, debility arising from fatigue, too much sun, or intemperance brought the fever to fruition. Even then it was possible for the disease to lay innocently in the body if several exciting causes, fear, grief, cold, sleep without proper bed clothes, or "immoderate evacuation," didn't cause it to rage. As for all the preventatives so popular during the epidemic, he thought only chewing garlic had some benefit. Rush noted in passing that "Mosquetoes (the usual attendants of a sickly autumn) were uncommonly numerous," more proof of how unhealthy the air had been because bad insects thrived in bad air.
He described why the disease's great force mocked the stimulating remedies used in treating lesser fevers with another analogy. Yellow fever was "like a tedious equinoctial gale acting upon a ship at sea; its destructive force was only to be opposed by handing every sail, and leaving the system to float, as it were under bare poles." Hence the need for depleting remedies like purging and bleeding. Given the force of the disease his remedies were not drastic at all. They created "an artificial weak part in the bowels," and diverted "the force of the fever to them." That "saved the liver and brain from fatal or dangerous congestions." All criticisms leveled at mercury during the epidemic were unfounded. "Hundreds who took it declared they had never taken so mild a purge." Children took wrong doses with no ill affect. The salivation it caused was not inconvenient, especially when it's considered that it was a harbinger of a cure. Only one patient who achieved it subsequently died. Indeed toward the end of the epidemic his assistants rubbed mercury on the gums of patients to hasten salivation. Two people lost teeth, but those teeth had already been loose and decayed.
As for his bleeding being too copious he did not "lose a single patient whom I bled seven times or more." Rather than weakening patients, copious bleedings invigorated many, and in some cases cured chronic ailments too. Rush estimated that his methods saved the lives of 6,000 people. Yet God did more than provide a remedy for one fever. He provided a system so successful that medicine in the future would "consist more in a new application of established principles, and in new modes of exhibiting old medicines, than in the discovery of new theories, or of new articles of the materia medica."
After heralding a new era in therapeutics, Rush urged radical reforms in how medical care was provided. Bush Hill had complete provisions and country air, still 448 out of 807 patients died. In the next epidemic, people had to prescribe for themselves. "At the expense of an immense load of obloquy, I have addressed my publications to the people. The appeal though hazardous, in the present state of general knowledge in medicine, has succeeded.... (T)he pride and formalities of medicine, as far as they relate to this disease, are now completely discarded in our city, as the deceptions of witchcraft were, above a century ago." It only remained to increase the general knowledge of medicine. "The time must and will come, when... the general use of calomel, jalap, and the lancet, shall be considered among the most essential articles of the knowledge and rights of man.... All the knowledge that is necessary to discover when blood letting is proper, might be taught to a boy or girl of twelve years old in a few hours." As soon as yellow fever makes its appearance, a description of all symptoms which are the precursors to the disease should be published and people directed to purge and bleed immediately upon the onset of symptoms.
In the decade prior to the Philadelphia epidemic many observers had noted the increase in the incidence of fevers throughout America. Rush himself had written an essay on the problem in 1786 in which he blamed the increase in the number of mill ponds unprotected by purifying trees. With typical optimism Rush, and his student Currie, for that matter, documented this phenomena, and in the next breath, discounted its significance. Fevers would end once farmers became settled or noxious urban creeks were covered. Now the onslaught of such a deadly epidemic in the most civilized square mile in the new country forced a rethinking. Rush made Philadelphia's particular crisis, a passage for all Americans. The deadly fever was but the worst form of the common, nagging, debilitating fevers that chilled and shook all the milk and honey tomorrows, the promise of America. In conquering yellow fever he found the key to conquering the endemic discomforts that confronted all Europeans in the new land. And as was only proper in a universe created and continued through divine inspiration, there was a moral lesson in his discovery. The land dealer's paradigm of plenty, the pursuit of happiness through engorgement, had to give way to denial, depletion, and enforced starvation to the point of letting the stuff of life drain out of the body. Here was the Spirit of '76 that encouraged self-denial applied to the hazards that every change in season brought. Prevention depended on communal discipline directed toward scrupulous cleanliness and morality.
Rush's ideas served God. He looked down upon the recommendations of colleagues like Currie. In retrospect Currie was a better epidemiologist. He soon published a 15 page critique of Rush's book which detailed circumstantial evidence showing how the fever was rife in the West Indies, that people who had the fever boarded ships for Philadelphia, that passengers on ships from the islands were sick upon arriving in Philadelphia, and that the sick had been in Mrs.LeMaigre's kitchen and other boarding houses. The Englishman treated by Physick in early August had just come from a West Indian island. Currie also ridiculed Rush's contention that yellow fever was a higher grade of bilious fever. The former was contagious and affected the body differently. However Currie did not battle solely with the weapons of science. He may not have bent his arguments to glorify God, but he did glorify the city. His "Impartial Review of Rush and the Wholesomeness of the City Vindicated" concluded by pointing out that, judging from the bills of mortality, Philadelphia was the most healthy city in the world except during those rare years, 1762 and 1793, when yellow fever was imported into the city.
The next sickly season was fast approaching and more after that. Baltimore and New Haven had yellow fever epidemics in 1794, New York in 1795, Philadelphia in 1797, and all major ports from Baltimore to Boston in 1798. They tested the country as well as Rush's theories and practices. For a short history of scope of the epidemics in the 1790s go to A Short History of Yellow Fever
