8. The Yearly Meeting

As s Rush languished, the Quakers assembled for their Yearly Meeting. It would be unfair to say they were lured in by the favorable reports about the city a few days before. Those hopes had been dashed. That Sunday old Rev. James Sproat followed his daughter's body to the grave. Save for the blacks in the cart, he was alone. "It was truly an affecting sight," wrote John Welsh who saw the spectacle from his window, "to see the old man, enfeebled and tottering after the hearse deeply affected."

Thousands of people were trapped in the city for economic reasons. They had no where to flee or couldn't afford the expense. At many shops men who still had to eat still came to work. William Pollard, an iron and brass manufacture, didn't close fearing that his skilled workers would quit and perhaps go elsewhere. (A week later he was relieved when they were "frighted" enough to leave the city and he could close.)

Still the Quaker delegates from neighboring states and other Pennsylvania cities meetings came to Philadelphia. Benjamin Smith thought the meeting would make quick work of the business aspects of the society and adjourn promptly. Instead he found the "country friends generally pretty stout and no talk of adjourning." The 100 or so delegates and their spouses had a sense that God would protect them. They dutifully considered reports and held meetings for worship. Before the meetings ended three days later, those who came sent words of chastisement to the delegates who didn't. One of the most ecstatic of the society's spiritual leaders, Rebecca Jones, gloried in the courage displayed. At one meeting when a woman explained why she stayed in the city, Jones called her "a very preacher of righteousness."

There was a general recognition of the "love and unanimity" at the meetings. One Quaker wrote, "what an unspeakable mercy if those who have truly ventured 'as with their lives in their hands,' should be restored to their families well. They will have renewedly to believe they have been divinely supported." Not that all who came in were so saintly. John Pemberton managed to stay for only one day of meetings. Monday evening he felt sick, "took the means to promote perspiration," and went back to Germantown telling all that "the air in the city... affected me the first day I entered it."

 There was a measure of defiance in holding the meeting. Not a few in the city objected to meeting houses and churches remaining open for their usual schedule of services throughout the week. In Monday's General Advertiser, "Humanus" asked that such services stop since the disease was spread by "persons who have the noxious matter in their bodies, or impregnated with their clothes." Let services begin once "it shall please the Almighty to mitigate the severity of this dreadful and all-chastising scourge...." In a letter addressed to his fellow clergymen and printed in the newspapers, Rev. Robert Annan said that while he accepted "the judgment of God on this irreligious and licentious city," he thought churches should be closed. "The religion of Jesus is rational," and congregating in public was the best way to spread the disease.

 At the Presbyterian Church on Pine Street, the minister recited the arguments and put the question to a vote. The congregation voted unanimously "to continue God's worship as usual." In his memoir published a few months after the epidemic Rev. Henry Helmuth responded to the criticism. Before services a strong smoke of disinfecting juniper berries and oxygen-generating nitre was made throughout his church. When people arrived windows were opened. Those with sick at home were asked not to come. Everyone sat as far apart as possible. The service lasted no longer than half or three quarters of an hour, with much time devoted to advising the congregation on preventatives and precautions to take when with the sick. That said, Helmuth was quick to glory in the experience of coming together in God's house at such an affecting time. He marveled at "the silence, the attention, the emotions which were observed in our hearers! - Ah, what a sight, what a scene otherwise so rare! Even during the singing, tears began to flow..., which increased during the sermon to a soft sobbing; and then after the sermon - the humble supplication throughout our blessed Zion [Church] - the sighs - the groans, and the increased gust of tears.... My God! what hours were these! What comfort pervaded our otherwise distressed congregation!"

 Back in August Rush had urged citizens to avoid public assemblies, now he ignored the controversy. He was too busy to attend church services himself, and evidently in his talks with Helmuth, Father Fleming and other clergymen, he never encouraged them to stop services. However, he certainly thought encouraging healthy people from the countryside to come into the infected city, as the Quakers did, was foolhardy. But due to the sickness in his own house, and his own weakness, Rush's war against the fever entered a defensive phase. He no longer would try to direct traffic in the city, so to speak, telling people when to leave and when to enter. Seething with paranoia, his public messages were limited to one issue: the defense of his remedies.

Indirectly the Yearly Meeting caused him some grief. Along with the influx of outsiders came two letters attacking his methods. Dr. George Logan, Edinburgh '79, scion of a prominent Quaker family who had spent the entire epidemic on his farm, published a long essay in the General Advertiser arguing that bleeding was deadly in malignant fevers. Logan thought only those with "plethoric habits" i.e. big eaters and drinkers, should be bled. Dr. Thomas Ruston also wrote a letter warning against bleeding: "You may almost as well, clap a knife at once, to the throat, as present a lancet to the arm of your patient."

Rush dismissed Ruston as a "dull and profligate usurer who has not seen a sick man these seven years." Logan seldom saw patients either, but he was more respectable. In the evening Federal Gazette on Tuesday a note called attention to Ruston's and Logan's not practicing in years. "Dr. Rush," the note continued, "has beyond all doubt had the greatest success." On Thursday an item invited Ruston and Logan to join the physicians of Philadelphia in fighting the epidemic, "instead of insulting their understanding, and distracting the public mind by giving vain advice." Yet Rush could not simply shrug such criticism off. He got his real revenge on Logan in a letter to his wife. He dramatically recounted a visit he had made Monday afternoon to "a respectable Quaker family." (It was the only time in his letters he made such a pointed reference to the religion of a patient.) "I passed from the front door upstairs to the bedroom of the master of this family through a train of children weeping and blessing me as I went along." The patient had been bled "only three times" by Parke. Rush bled him a fourth time, and gave him "some strong mercurial purging pills." (In his essay Logan had expressed some doubts as to Rush's dosage.) "I left the family with a hope only of his recovery. This at that time was enough. They seized the word as if it conveyed a kingdom to them."

Rush never mentioned this respectable nameless Quaker family again. Rush certainly needed such adulation that afternoon. At 12:30 p.m. Stall died. No death affected Rush. He told his wife that the boy was "prepared and composed for his fate." He died doing "his Master's work - healing the sick and relieving the distressed. Thousands who witnessed his zeal and boldness in rushing into danger lament his death." Meanwhile his other apprentice Fisher took his medicine and seemed out of danger. Marcus was well. Rush felt better that Monday. He was getting his strength back. With the black man driving, Rush took advantage of pleas from two families in the country with fever victims to get some relief from the oppressive atmosphere of the city. On Tuesday morning the wind blew from the northeast bringing clouds and cooler temperatures. Rush hoped that it was a sign of a coming "equinoctial gale."

In his memoir of the epidemic, as was traditional in medical histories, he would note various natural phenomena at occurred in 1793. Blossoms appeared on fruit trees by the first of April; birds appeared two weeks earlier in the spring; the heat and drought of the summer were uncommon; a meteor was seen at 2 a.m. "on or about the twelfth of September" and fell on Pine Street; mosquitoes were numerous; cats died and perhaps not just because their owners had abandoned them; cherry trees blossomed in October; the weather did not change as expected with the changes in the moon. Yet in the letters he wrote at the time, the only natural phenomena he harped on, other than the ever present heat, was the storm so often experienced around the autumnal equinox that never came.

Evidently the remnants of enough hurricanes had swept the northeast to impress people that it was a necessary violent cleansing of the atmosphere. "An equinoctial gale with rain would do more for our city than a thousand physicians," he explained to his wife. The next day he lamented the shining sun and the return of warm weather. That inspired another spasm of resignation: "But God's will is done on earth as much by pestilential contagion and ignorant physicians as it is by the songs and praises of saints and angels in heaven."

A few sentences later he lamented the "want of bleeders as well as doctors." With apothecary shops closing, many "were unable to procure the mercurial purges when they are prescribed as soon as is necessary," it meant that "the help of man is now at an end." He hoped "the hour is not distant when God will make bare his arm for our deliverance." He felt better but his strength did not return. He stayed at home, prescribing for visitors. Too weak to even sit Arabian fashion on the floor, he lay on his couch dispensing advice and hope. In the evening he worked on his notes of the epidemic, careful to transcribe and amplify on them in a legible hand so that if he did die his great work would not be lost.

He suffered another embarrassment when John Alston, an apprentice of his from South Carolina who had only visited four or five patients, died. He had spent most of the epidemic attending a Miss Wilson. Rush had no trouble explaining away the death to Julia: "I saw him but three times in a disease which required three and thirty visits. He refused to be bled for nearly a whole day because I was unable to visit him, and life and death often turn upon the application of a remedy at an hour or a moment in this ferocious disease."

Gone were the days of treating the fever as a common cold. It is difficult to get an objective measure of Rush's growing respect for the disease since his letters were so evidently a medium through which he maintained the confidence required in that hour of crisis. But as the epidemic wore on, there were cracks in his confidence. He mentioned prescribing for an acquaintance in his back parlor and lamented that he could not promise a cure because he would be unable to attend the man in his lodgings. His increased respect for the fever and awareness of his limitations did not cause him to reassess his remedies and directions, perhaps because he no longer had the energy for new discoveries. Instead he grasped at signs that propped up his previous optimism.

A finger he had cut began to heal despite being exposed to so much contagion. He deemed it proof that his vegetable and milk diet, and his avoidance of fatigue, were indeed the best preventatives. As he worked on his notes getting such a confirmation was vital. Coxe, his one remaining apprentice who was able to get about, came back with more information on Alston. He had actually been in little danger. He died after puking and that was caused by an ignorant black nurse giving him a pint of cold water after he had taken a dose of medicine, instead of giving him tepid chicken water before the dose. And even if Alston could be said to have died of Rush's treatment, Dr. Lynn had died about the same time under the care of "bark and wine doctors."

Rush was intent on proving the efficacy of bleeding and purging. In the letters he wrote at the time and subsequent writings his successes were expressed in relation to the number of times the patient was bled. For example, in his letters Rush noted only that Samuel Meredith was better again "after four bleedings." The letters Mrs. Meredith wrote to Rush tell a different story. Meredith suffered from head pains for which Rush prescribed hot cabbage leafs on the skin that would raise blisters as well as calomel. When stomach pains began to predominate, Mrs. Meredith, evidently with Rush's approval, gave her husband laudanum. Indeed her letters never mentioned bleeding.

Rush obviously saw bleeding as the crucial remedy that controlled the fever, and in his writings he ascribed cures to bleeding alone. But when with patients he followed the medical practice of the time and treated all symptoms. To the medical revolutionary all that was not worth mentioning. Patients however viewed bleeding as a mysterious operation. Perhaps at first it did help relax the patient, but subsequent bleedings had no perceptible affect, other than to weaken the patient.

Thursday morning the 26th, Rush was back in his carriage, out to battle the foe. Whenever he felt faint he sipped some "Lisbon wine," which he carried in a vial in his pocket. Washing his mouth with it restored him momentarily. Although he recognized that the poor bore the brunt of the epidemic, in his weakened condition, Rush decided he could only visit his old patients, those who had been using and paying for his services for years. One of the first patients he saw was Van Berckel the Dutch ambassador, who had believed Kuhn and Currie and suffered five days thinking he had a common fever. Rush probably lectured him with the same zeal he wrote to his wife that morning: "Hundreds have been sacrificed by this mistake. We have but one, we cannot have but one fever in town. The contagion of the yellow fever like Aaron's rod swallows up the seeds of all other diseases. We might as well talk of two suns or two moons shining upon our globe as of two different kinds of fevers now in our city." (What Van Berckel thought of that assertion is not known. John Welsh, for one, thought it "absurd." The city suffered from "colds, agues and slow fevers." When Welsh himself was prostrated with chills, sweats, fever, pains in his chest and blood in his spittle, he wrote, in a very shaky hand, that his trying symptoms arose from "3 complaints, a cold, bilious and intermitting fever." While not "afraid of its being the yellow fever," he thought it wasn't because he had "no desire to puke.")

Rush also saw Dr. Redman and Samuel Powel who were not well at all. Rush told his wife that Redman was "in great danger." Powel was worse and completely separated form his family. His wife, who was in Chester at her brother's estate, her refuge in lieu of Mount Vernon, sent expresses twice a day but doubtlessly was forbidden by her husband to come herself. Powel got the fever as he was commuting from Chester to his townhouse on South Third Street. He found a bed in a small, bare farm house he owned just across the Schuylkill River, then sent a messenger to Rush, and Rush sent back a prescription. Powel hired a young doctor in the neighborhood to attend him and follow Rush's orders. Later in the day, after the bleeding and purging, Powel sent a note back to Rush: "I certainly don't feel worse for the operation. The discharge from my bowels are exactly as you described them."

 When Rush returned to Walnut Street he had fresh reminders of his loneliness. At noon his last apprentice, John Coxe, left, "went home," Rush told Julia, "with the prevailing fever." And Rush's sister Rebecca, "with fatigue and anxiety, retreated to her bed,... very ill." Only Rush and Marcus prepared doses of calomel and jalap. Then Rush was devastated after reading a letter in the newspaper by the still convalescing Caspar Wistar. After describing his consultations with Rush early in his illness, and how calomel and jalap relieved him, Wistar said he was not sure if mercurials or milder saline cathartics were better. That said, he endorsed cold air as the best remedy. Having the window open had revived him far more than any medicine. Wistar also acknowledged Kuhn for stopping his diarrhea with laudanum, and prescribing a "tincture amara" which, after sipping for every two hours for 24 hours, allowed Wistar to "eat rice and chocolate without suffering."

 After reading that Rush threw down the paper, and quoted Shakespeare's "This was the most unkindly cut of all...." Wistar was his Brutus. There was no one there to reassure him. His mother went to bed early, so he had "to pass three or four gloomy hours in the back parlor by myself." He wrote to his wife, but saved his counterattack against Wistar for the morning. "In vain did I strive to forget my melancholy situation," he wrote in his memoir of the epidemic, "by answering letters and by putting up medicines. My faithful black man crept to my door, and at my request sat down by the fire, but he added, by his silence and dullness, to the gloom, which suddenly overpowered every faculty of my mind." Rush rallied in the morning with the help of the 121st Psalm: "The Lord shall preserve thee from all evil...." He lashed out at Wistar in his morning letter to his wife. Wistar's letter was "certainly calculated to injure me and to create doubts as to the efficacy of the new remedies."

Rush fancied himself like the French Republic, surrounded by enemies. But he would spite the "dull and wicked confederacy, having resolved to stick to my principles, my practice, and my patients, through divine support, to the last extremity." If he survived the epidemic and they then drove him from the city, he would wield "the plow with as much composure of mind as I now wield the lancet." He would teach country school instead of medical school. He also wrote a short letter for publication chiding Wistar. If he had taken more calomel as Rush had prescribed it, he would have recovered quickly and been back at work, "uniting at the same time, his testimony, with that of thousands of his fellow citizens, in favor of that excellent remedy."

In 1797, William Currie recalled that Rush terrified many "into chilly fits, some into relapses, and some into convulsions by stopping them in the street and declaring they had the fever. 'You've got it! You've got it!' was his usual salutation upon seeing anyone with a pale countenance." Many tarred him with inflicting the city with grasping Negroes who spread the disease as they stole from its victims. To John Welsh the deaths of Rush's apprentices proved that the disease "is only to be taken by respiration, or contact with a Negro attendant. The Negroes I always avoid." A young English printer complained that the black nurses' wages were "shamefully high." In 1797, William Currie described the work of Jones and Allen as Rush's greatest crime against the city. The "two illiterate Negro men" were "appointed" by Rush and sent "into all the alleys in the city with orders to bleed and give his sweating purges,... to all they should find sick without regard to age, sex or constitution. And bloody and dirty work they made among the poor miserable creatures that fell in their way."

At Bush Hill, Dr. Deveze suspected that many came to him in such debilitated condition because of taking Rush's purges. On October 1, he cut open a corpse of a man who said he had taken some. Deveze found his "abdominal muscles were in such a state of contraction as to flatten the belly in a manner that it almost touched the backbone." At the hospital, Deveze treated patients with glysters, cooling drinks and baths. A favored tonic was the gentian flower called centaury. Deveze bled but not as copiously as Rush. His special touch was a machine he salvaged from his practice in St. Domingo that made a "fixed air" drink, i.e. carbonated water. He also used blisters all over the body depending on symptoms. Still about half the patients died within three days of entering the hospital.

Some members of the mayor's Committee members made a point of not sending patients to Bush Hill.  John Connelly distributed Rush's pills. He told Rush that he found time and again that if the poisonous bile was in the body for over 10 or 12 hours, "patients rarely recovered." Those who refused calomel, saying they had the common fall fever, usually died.

His exertions Thursday and Wistar's attack weakened Rush enough that he stayed home Friday. Not that he was in the dumps again. He noted to Julia, "the sky again lowers, and a few drops of rain have fallen. Thousands revive at the sight." His sister was not among that number. She remained very ill. Rush could not do much for her, and what he did do, he never described. He decided the weakness and disease which had kept him at home so many days were providential. "Hundreds more, especially of the poor, have been relieved by my advice at home whom I could not have visited and who would otherwise probably have died." It was a curious claim to make while his sister was dying upstairs, a gasp of optimism before he faced the most terrible dimension of the epidemic, helplessness as a family member died.

Go to Chapter 9