The Philadelphia 1793 yellow fever epidemic was an epidemic that took place in Philadelphia. During the epidemic, 5,000 or more people died between August 1 and November 9. The vast majority of them died of yellow fever, making the epidemic in the city of 50,000 people, one of the most severe in United States history. By the end of September, 20,000 people had fled the city, including congressional and executive officials of the federal government of the United States. Most did not return until after the epidemic had abated in late November. The mortality rate peaked in October before frost finally killed the mosquitoes and brought an end to the outbreak. Doctors tried a variety of treatments but knew neither the origin of the fever nor that the disease was transmitted by mosquitoes (this information was not verified until the late 19th century).
Matthew Clarkson, the mayor of Philadelphia, and a committee of two dozen organized a fever hospital at Bush Hill and other crisis measures. The assistance of the Free African Society was requested by the city and readily agreed to by its members. Parties mistakenly assumed that people of African descent would have partial immunity to the new disease. Black nurses aided the sick, and the group's leaders hired additional men to take away corpses, which most people would not touch. But black people in the city died at the same rate as whites, about 240 altogether.
Some neighboring towns refused to let refugees in from Philadelphia, fearing that they were carrying the fever. Major port cities, including Baltimore and New York City, had quarantines against refugees and goods from Philadelphia, although New York City sent financial aid to Philadelphia.
Beginnings
In the spring of 1793, French colonial refugees, some with slaves, arrived from Cap Français, Saint-Domingue, in present-day Haiti. The 2,000 immigrants fled the slave revolution in the island's north. They crowded the port of Philadelphia, where the first yellow fever epidemic in the city in 30 years began. It is likely that the refugees and ships carried the yellow fever virus and mosquitoes. Mosquito bites transmit the virus. Mosquitoes easily breed in small amounts of standing water. The medical community and others in 1793 did not understand the role of mosquitoes in the transmission of yellow fever, malaria, and other diseases.
In the ports and coastal areas of the United States, even in the northeast, the months of August and September were considered the "sickly season," when fevers were prevalent. In the South, planters and other wealthy people usually left the Low Country during this season. Natives thought that newcomers, especially, had to undergo a "seasoning" and were more likely to die of what were thought to be seasonal fevers in their early years in the region. In 1793, Philadelphia was the temporary capital of the United States, and the government was due to return in the fall. President George Washington left the city for his Mount Vernon estate.
The first two people to die of yellow fever in early August in Philadelphia were both recent immigrants, one from Ireland and the other from Saint-Domingue. Letters describing their cases were published in a pamphlet approximately a month after they died. The young doctor sent by the Overseers of the Poor to treat the Irish woman was perplexed, and his treatment did not save her.
A 2013 book by Billy G. Smith, professor of history at Montana State University, makes a case that the principal vector of the 1793 plague in Philadelphia (and other Atlantic ports) was the British merchant ship Hankey, which had fled the West African island colony on Bolama the previous November. It trailed yellow fever at every port of call in the Caribbean and eastern Atlantic seaboard.
Epidemic declared
Dr. Benjamin Rush was a doctor's apprentice during the city's 1762 yellow fever epidemic, and after two weeks and an increasing number of fever cases, he recognized the pattern. Rush alerted his colleagues and the government that the city faced an outbreak of "highly contagious, as well as mortal... bilious remitting yellow fever." Adding to the alarm was that, unlike with most fevers, the principal victims were not very young or very old. Many of the early deaths were teenagers and heads of families in the dockside areas. Believing that the refugees from Saint-Domingue were carrying the disease, the city imposed a quarantine of two to three weeks on immigrants and their goods. However, the government was unable to enforce it as the epidemic spread further.
Philadelphia was the largest city in the US, with around 50,000 residents, and most houses were within seven blocks of its major port on the Delaware River—docking facilities extended from Southwark south of the city, to Kensington to the north. Cases of fever clustered at first around the Arch Street wharf. Rush blamed "some damaged coffee which putrefied on the wharf near Arch Street" for causing the fevers. Soon, cases appeared in Kensington. As the port was critical to the state's economy, Pennsylvania Governor Thomas Mifflin had responsibility for its health. He asked the port physician, Dr. James Hutchinson, to assess the conditions. The doctor found that 67 of about 400 residents near the Arch Street wharf were sick, but only 12 had "malignant fevers."
Rush later described some early cases: On August 7, he treated a young man for headaches, fever, and vomiting, and on August 15 he treated his brother. On the same day, a woman he was treating turned a yellowish color. On August 18 a man on the third day of fever had no pulse, was cold, clammy, and yellow, but he could sit up in his bed. He died a few hours later. On August 19 a woman Rush visited died within hours. Another physician said five people within sight of her door died. None of those victims was a recent immigrant.
The college published a letter in the city's newspapers, written by a committee headed by Rush, suggesting 11 measures to prevent the "progress" of the fever. They warned citizens avoid unnecessary contact with people who are sick and to avoid fatigue, the hot sun, cold night air, excessive drinking, and anything else that might lower their resistance. Vinegar and camphor in infected rooms "cannot be used too frequently upon handkerchiefs, or in smelling bottles, by persons whose duty calls to visit or attend the sick." They outlined measures for city officials, including stopping the tolling of church bells and making burials private, cleaning streets and wharves, and exploding gunpowder on the roads to increase the amount of oxygen. Crews were sent to clean the wharves, streets, and the market, which cheered those remaining in the city. Many of those who could left the city.
Elizabeth Drinker, a Quaker woman, kept a journal for years; her account from August 23 through August 30 tells the story of the disease's rapid spread in the city and the rising toll of deaths. She also describes the many people leaving the city.
Temporary hospitals
Like all hospitals of that time, the Pennsylvania Hospital did not admit patients with infectious diseases. The Guardians of the Poor took over Bush Hill, a 150-acre estate farther outside the city, whose owner, William Hamilton, was in England for an extended stay. Vice President John Adams had recently rented the main house, so yellow fever patients were placed in the outbuildings.
Panic and refugees
Between the college's advisory on August 25 and the death of Dr. Hutchinson from yellow fever on September 7, panic spread throughout the city; more people fled. Between August 1 and September 7, 456 people died in the city; 42 deaths were reported on September 8. An estimated 20,000 people left the city through September, including national leaders. The daily death toll remained above 30 until October 26. The worst seven-day period was between October 7 and 13, when 711 deaths were reported.
Mathew Carey published a short pamphlet later in the fall in which he describes the changes that had occurred in the life of the city:
"Those who ventured abroad had handkerchiefs or sponges impregnated with vinegar of camphor at their noses, or smelling-bottles full of the thieves' vinegar. Others carried pieces of tarred rope in their hands or pockets, or camphor bags tied round their necks... People hastily shifted their course at the sight of a hearse coming towards them. Many never walked on the footpath, but went into the middle of the streets, to avoid being infected in passing by houses wherein people had died. Acquaintances and friends avoided each other in the streets, and only signified their regard by a cold nod. The old custom of shaking hands fell into such general disuse that many shrank back with affright at even the offer of a hand. A person with crape, or any appearance of mourning, was shunned like a viper."
African American nurses
The College of Physicians' advisory implied the fever was contagious and people should avoid contact with its victims, although "duty" required that they be cared for. Yet in families, when the person with the fever was a mother or father, they could forbid their children from coming near them. Rush knew of Dr. John Lining's observation during the 1742 yellow fever epidemic in Charleston, South Carolina, that African slaves appeared to be affected at rates lower than Whites; he thought they had a natural immunity. Writing a short letter to the newspapers under the pseudonym "Anthony Benezet," a Quaker who had provided schooling for blacks, Rush suggested that the city's blacks had immunity and solicited them "to offer your services to attend the sick to help those known in distress."
Richard Allen and Absalom Jones recall their reaction to the letter in a memoir they published shortly after the epidemic:
Early in September, a solicitation appeared in the public papers, to the people of colour to come forward and assist the distressed, perishing, and neglected sick; with a kind of assurance, that people of our colour were not liable to take the infection. Upon which we and a few others met and consulted how to act on such a truly alarming and melancholy occasion. After some conversation, we found the freedom to go forth, confiding in Him who can preserve amid a burning fiery furnace, sensible that it was our duty to do all the good we could to our suffering fellow mortals. We set out to determine where we could be of use. The first we visited was a man in Emsley's alley, who was dying, and his wife lay dead at the time in the house; there were none to assist but two poor, helpless children. We administered what relief we could, and applied to the overseers of the poor to have the woman buried. We visited upwards of 20 families that day—they were scenes of woe indeed! The Lord was plentiful to strengthen us, and removed all fear from us...
To better regulate our conduct, we called on the mayor the next day, to consult with him on how to proceed, to be the most useful. The first object he recommended was a strict attention to the sick and the procuring of nurses. Absalom Jones and William Gray attended to this, and so that the distressed might know where to apply, the mayor advised that upon application to them, they would be supplied. Soon after, the mortality increased, and the difficulty of getting a corpse taken away was such that few were willing to do it when offered great rewards. The black people were looked at. We then offered our services in the public papers, by advertising that we would remove the dead and procure nurses. Our services were the production of real sensibility—we sought not fee nor reward, until the increase of the disorder rendered our labour so arduous that we were not adequate to the service we had assumed.
Allen notes in his account that because of the increase in mortality, he and Jones had to hire five men to assist them in removing corpses, as most people avoided the sick and the dead. In a September 6 letter to his wife, Rush writes the "African brethren ... furnish nurses to most of my patients." Despite Rush's theory, most of the city's black residents, who were born in North America, were not immune to the fever. Many of the slaves in Charleston in 1742 could have gained immunity before having been transported from Africa, by having been exposed to yellow fever in a mild case. People who survived one attack gained immunity. A total of 240 blacks died in Philadelphia, in proportion to their population at the same rate as whites.
Controversy over treatment
Given the limited resources and knowledge of the times, the city's response was credible. The medical community did not know the natural history of yellow fever, a viral infection spread by the Aedes aegypti mosquito. Efforts to clean the city did not defeat the spread of the fever, as the mosquitoes breed in clean water as well as in dirty water. Philadelphia's newspapers continued to publish during the epidemic, and doctors and other health professionals worked to understand and combat the disease. On September 7, Dr. Adam Kuhn, who had studied medicine at the University of Uppsala in Sweden, advised patients to treat symptoms as they arose.
Rush claimed that he had tried Kuhn's and Steven's stimulating remedies but that his patients still died. He recommended other treatments, including purging and bloodletting, and published his theories. The hope offered by any of these treatments was soon dashed when it became clear that they did not cure the disease, and the doctors' competing claims demoralized patients.