Infectious and Epidemic Disease in History

Department of History
University of California, Irvine
 Instructor:    Dr. Barbara J. Becker

Week 7.  Cure?

A Short Account of the Malignant Fever Lately Prevalent in Philadelphia... (1794)
by Mathew Carey (1760-1839)

Chap. I.  The State of Philadelphia...
...In July [1793], arrived the unfortunate fugitives from Cape François [Haiti]....

About this time, this destroying scourge, the malignant fever, crept in among us, and nipped in the bud the fairest blossoms that imagination could form.  And oh! what a dreadful contrast has since taken place!  Many women, then in the lap of ease and contentment, are bereft of beloved husbands, and left with numerous families of children to maintain, unqualified for the arduous task -- many orphans are destitute of parents to foster and protect them -- many entire families are swept away, without leaving "a trace behind" -- many of our first commercial houses are totally dissolved, by the death of the parties, and their affairs are necessarily left in so deranged a state, that the losses and distresses which must take place, are beyond estimation.  The protests of notes for a few weeks past, have exceeded all former examples; for a great proportion of the merchants and traders having left the city, and been totally unable, from the stagnation of business, and diversion of all their expected resources, to make any provision for payment, most of their notes have been protested, as they became due....

Chap. II.  The Symptoms... [as described by Dr. William Currie in a letter to Dr. Senter]

"The symptoms which characterised the first stage of the fever, were, in the greatest number of cases, after a chilly fit of some duration, a quick, tense pulse -- hot skin -- pain in the head, back, and limbs -- flushed countenance -- inflamed eye -- moist tongue -- oppression and sense of soreness at the stomach, especially upon pressure -- frequent sick qualms, and retchings to vomit, without discharging any thing, except the contents last taken into the stomach -- costiveness [constipation], &c.  And when stools were procured, the first generally showed a defect of bile, or an obstruction to its entrance into the intestines.  But brisk purges generally altered this appearance.

"These symptoms generally continued with more or less violence from one to three, four, or even five days; and then gradually abating, left the patient free from every complaint, except general debility.  On the febrile symptoms suddenly subsiding, they were immediately succeeded by a yellow tinge in the opaque cornea, or whites of the eyes -- an increased oppression at the precordia -- constant puking of every thing taken into the stomach, with much straining, accompanied with a hoarse hollow noise.

"If these symptoms were not soon relieved, a vomiting of matter, resembling coffee grounds in colour and consistence, commonly called the black vomit, sometimes accompanied with, or succeeded by hemorrhages from the nose, fauces [back of the throat], gums, and other parts of the body -- a yellowish purple colour, and putrescent appearance of the whole body, hiccup, agitations, deep and distressed sighing, comatose delirium, and finally death.  When the disease proved fatal, it was generally between the fifth and eighth days...."

This disorder having been new to nearly all our physicians, it is not surprising, although it has been exceedingly fatal, that there arose such a discordance of sentiment on the proper mode of treatment, and even with respect to its name.

Dr. Rush has acknowledged, with a candour that does him honour, that in the commencement, he so far mistook the nature of the disorder, that in his early essays, having depended on gentle purges of salts to purify the bowels of his patients, they all died.

He then tried the mode of treatment adopted in the West Indies, viz. bark ["Peruvian bark," or cinchona; natural source of quinine used to treat the symptoms of malaria], wine, laudanum [opium mixed with water], and the cold bath, and failed in three cases out of four.  Afterwards he had recourse to strong purges of calomel [mercurous chloride, a white, tasteless powder that darkens on exposure to light] and jalap [dried root of a Mexican vine (Ipomoea purga) of the morning glory family, used as a purgative], and to bleeding, which he found attended with singular success.

The honour of the first essay of mercury in this disorder, is by many ascribed to Dr. Hodge and Dr. Carson, who are said to have employed it a week before Dr. Rush.  On this point I cannot pretend to decide.  But whoever was the first to introduce it, one thing is certain, that its efficacy was great, and rescued many from death.  I have known, however, some persons, who, I have every reason to believe, fell sacrifices to the great reputation this medicine acquired; for in several cases it was administered to persons of a previous lax habit, and brought on a speedy dissolution.

I am credibly informed that the demand for purges of calomel and jalap, was so great, that some of the apothecaries could not mix up every dose in detail; but mixed a large quantity of each, in the ordered proportions; and afterwards divided it into doses; by which means, it often happened that one patient had a much larger portion of calomel, and another of jalap, than was intended by the doctors.  The fatal consequences of this may be easily conceived....

The efficacy of bleeding, in all cases not attended with putridity, was great.  The quantity of blood taken was in many cases astonishing.  Dr. Griffits was bled seven times in five days, and appears to ascribe his recovery principally to that operation....

Dr. Rush and Dr. Wistar have spoken very favourably of the salutary effects of cold air, and cool drinks, in this disorder.  The latter says, that he found more benefit from cold air, than from any other remedy.  He lay delirious, and in severe pain, between a window and door, the former of which was open.  The wind suddenly changed, and blew full upon him, cold and raw.  Its effects were so grateful, that he soon recovered from his delirium -- his pain left him -- in an hour he became perfectly reasonable -- and his fever abated.

Chap. III.  First Alarm in Philadelphia...
It was sometime before the disorder attracted public notice.  It had in the mean while swept off many persons.  The first death that was a subject of general conversation, was that of Peter Aston, on the 19th of August, after a few days illness....

The first official notice taken of the disorder, was on the 22d of August, on which day the mayor ... gave ... orders, to have the streets properly cleansed and purified by the scavengers, and all the filth immediately hawled away....

On the 26th of the same month, the college of physicians had a meeting, at which they took into consideration the nature of the disorder, and the means of prevention and of cure ... recommending to avoid all unnecessary intercourse with the infected; to place marks on the doors or windows where they were; to pay great attention to cleanliness and airing the rooms of the sick; to provide a large and airy hospital in the neighbourhood of the city for their reception; to put a stop to the tolling of the bells; to bury those who died of the disorder in carriages and as privately as possible; to keep the streets and wharves clean; to avoid all fatigue of body and mind, and standing or sitting in the sun, or in the open air; to accommodate the dress to the weather, and to exceed rather in warm than in cool clothing:  and to avoid intemperance, but to use fermented liquors, such as wine, beer and cider, with moderation.  They likewise declared their opinion, that fires in the streets were very dangerous, if not ineffectual means of stopping the progress of the fever, and that they placed more dependance on the burning of gunpowder.  The benefits of vinegar and camphor, the added, were confined chiefly to infected rooms; they could not be too often used on handkerchiefs, or in smelling bottles, by persons who attended the sick....

The 29th, the governor of the state wrote a letter to the mayor, strongly enforcing the necessity of the most vigorous and decisive exertions "to prevent the extension of, and to destroy, the evil."

[And] it was agreed to be indispensably necessary that a suitable house, as an hospital, should be provided near the city for the reception of the infected poor....  [A] committee of the guardians [of the poor] ... judged that a building adjacent to Bushhill (site 4 on map of Philadelphia below), the mansion house of William Hamilton, esq. was the best calculated for the purpose....

Philadelphia, 1793

Chap. IV.  General Despondency...

The consternation of the people of Philadelphia at this period was carried beyond all bounds.  Dismay and affright were visible in almost every person's countenance.  Most of those who could by any means make it convenient, fled from the city.  Of those who remained, many shut themselves up in their houses, and were afraid to walk the streets.  The smoke of tobacco being regarded as a preventative, many persons, even women and small boys, had segars [cigars] almost constantly in their mouths.  Others placing full confidence in garlic, chewed it almost the whole day; some kept it in their pockets and shoes.

Many were afraid to allow the barbers or hair-dressers to come near them, as instances had occurred of some of them having shaved the dead -- and many having engaged as bleeders.  Some, who carried their caution pretty far, bought lancets for themselves, not daring to be bled with the lancets of the bleeders.  Many houses were hardly a moment in the day free from the smell of gunpowder, burned tobacco, nitre, sprinkled vinegar, &c.

Some of the churches were almost deserted, and others wholly closed.  The coffee house was shut up, as was the city library, and most of the public offices -- three out of the four daily papers were discontinued, as were some of the others.

Many were almost incessantly employed in purifying, scouring, and whitewashing their rooms.  Those who ventured abroad, had handkerchiefs or sponges impregnated with vinegar or 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.

The corpses of the most respectable citizens, even of those who did not die of the epidemic, were carried to the grave, on the shafts of a chair, the horse driven by a negro, unattended by a friend or relation, and without any sort of ceremony.  People hastily shifted their course at the sight of a hearse coming towards them.  Many never walked on the foot path, 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 shrunk back with affright at even the offer of the hand.  A person with a crape, or any appearance of mourning, was shunned like a viper.  And many valued themselves highly on the skill and address with which they got to windward of every person whom they met.

Indeed it is not probable that London, at the last stage of the plague, exhibited stronger marks of terror, than were to be seen in Philadelphia, from the 25th or 26th of August, till pretty late in September.  When people summoned up resolution to walk abroad, and take the air, the sick cart conveying patients to the hospital, or the hearse carrying the dead to the grave, which were travelling almost the whole day, soon damped their spirits, and plunged them again into despondency.

While affairs were in this deplorable state, and people at the lowest ebb of despair, we cannot be astonished at the frightful scenes that were acted, which seemed to indicate a total dissolution of the bonds of society in the nearest and dearest connexions.  Who, without horror, can reflect on a husband, married perhaps for twenty years, deserting his wife in the last agony -- a wife unfeelingly abandoning her husband on his death bed -- parents forsaking their only children -- children ungratefully flying from their parents, and resigning them to chance, often without an enquiry after their health or safety -- masters hurrying off their faithful servants to Bushhill, even on suspicion of the fever, and that at a time, when, like Tartarus, it was open to every visitant, but never returned any -- servants abandoning tender and human masters who only wanted a little care to restore them to health and usefulness --who, I say, can think of these things without horror?

Yet they were daily exhibited in every quarter of our city; and such was the force of habit, that the parties who were guilty of this cruelty, felt no remorse themselves -- nor met with the execration from their fellow-citizens, which such conduct would have excited at any other period.  Indeed, at this awful crisis, so much did self appear to engross the whole attention of many, that less concern was felt for the loss of a parent, a husband, a wife, or an only child, than, on other occasions, would have been caused by the death of a servant, or even a favorite lap-dog....

Chap. V.  Distress Increases...

Never, perhaps, was there a city in the situation of Philadelphia at this period.  The president of the United States [George Washington] according to his annual custom, had removed to Mount Vernon with his household.  [From 1790 to 1800, Philadelphia served as the seat of national government for the United States.  When the first census was taken in 1790, Philadelphia ranked as the new nation's most populous city with nearly 43,000 residents.]  Most, if not all of the other officers of the federal government were absent.  The governor, who had been sick, had gone, by directions of his physician, to his country seat near the falls of the Schuylkill [pronounced SKOO-kle]--and nearly the whole of the officers of the state had likewise retired.  The magistrates of the city, except the mayor, and John Barclay, esq. were away....  In fact, government of every kind was almost wholly vacated, and seemed, by tacit, but universal consent, to be vested in the committee [of ten appointed citizens].

Chap. VI.  Magnanimous offer...

At the meeting on Sept. 15th ... Stephen Girard, a wealthy merchant, a native of France, and one of the members of the [citizens] committee, touched with the wretched situation of the sufferers at Bush-hill, voluntarily and unexpectedly offered himself as a manager to superintend that hospital.  The surprise and satisfaction, excited by this extraordinary effort of humanity, can be better conceived than expressed.  Peter Helm, a native of Pennsylvania, also a member, actuated by the like benevolent motives, offered his services in the same department....

Chap. XIII.  Disorder Fatal to the Doctors...

Rarely has it happened, that so large a proportion of the gentlemen of the faculty have sunk beneath the labours of their very dangerous profession, as on this occasion.  In five or six weeks, exclusive of medical students, no less than ten physicians have been swept off....

To the clergy it has likewise proved very fatal.  Exposed, in the exercise of the last duties to the dying, to equal danger with the physicians, it is not surprising that so many of them have fallen....

Among the women, the mortality has not by any means been so great, as among the men, nor among the old and infirm as among the middle-aged and robust.

To tipplers and drunkards, and to men who lived high, and were of a corpulent habit of body, this disorder was very fatal....

To the filles do joie [prostitutes], it has been equally fatal....

To hired servant maids it has been very destructive....

It has been dreadfully destructive among the poor.  It is very probable, that at least seven eighths of the number of the dead, were of that class....

The mortality in confined streets, small allies, and close houses, debarred of a free circulation of air, has exceeded, in a great proportion, that in the large streets and well-aired houses.  In some of the allies, a third or fourth of the whole of the inhabitants are no more....  It is to be particularly remarked, that in general, the more remote the streets were from Water street, the less they experienced of the calamity.

From the effects of this disorder, the French newly settled in Philadelphia, have been in a very remarkable degree exempt.  To what this may be owing, is a subject deserving particular investigation.  By some it has been ascribed to their despising the danger.  But, though this may have had some effect, it will not certainly account for it altogether; as it is well known that many of the most courageous persons in Philadelphia, have been among its victims.  By many of the French, the great fatality of the disorder has been attributed to the vast quantities of crude and unwholesome fruits brought to our markets, and consumed by all classes of people.

When the yellow fever prevailed in South Carolina, the negroes, according to that accurate observer, Dr. Lining, were wholly free from it.  "There is something very singular in the constitution of the negroes," says he, "which renders them not liable to this fever; for though many of them were as much exposed as the nurses to this infection, yet I never knew one instance of this fever among them, though they are equally subject with the white people to the bilious fever."  The same idea prevailed for a considerable time in Philadelphia; but it was erroneous.

They did not escape the disorder; however, there were scarcely any of them seized at first, and the number that were finally affected, was not great; and as I am informed by an eminent doctor, "it yielded to the power of medicine in them more easily than in the whites."

The error that prevailed on this subject had a very salutary effect; for at an early period of the disorder, hardly any white nurses could be procured; and, had the negroes been equally terrified, the sufferings of the sick, great as they actually were, would have been exceedingly aggravated.

At the period alluded to, the elders of the African church met, and offered their assistance tot he mayor, to procure nurses for the sick, and to assist in burying the dead.  Their offers were accepted; and Absalom Jones, Richard Allen, and William Gray, undertook the management of these two several services.

The great demand for nurses afforded an opportunity for imposition, which was eagerly seized by some of the vilest of the blacks.  They extorted two, three, four, and even five dollars a night for such attendance, as would have been well paid by a single dollar.  Some of them were even detected in plundering the houses of the sick.  But it is unjust to cast a censure on the whole for this sort of conduct, as many people have done....

Chap. [XIV].  State of the Weather...

The weather, during the whole of the months of August and September, and most part of October, was remarkably dry and sultry.  Rain appeared as if entirely at an end.  Various indications, which in scarcely any former instance had ever failed to produce wet weather, disappointed the expectations, the wishes, and the prayers of the citizens.  The disorder raged with increased violence as the season advanced towards the fall months.  The mortality was much greater in September, than in August -- and still greater in the beginning and till the middle of October, than in September.  It very particularly merits attention, that though nearly all the hopes of the inhabitants rested on cold and rain, especially the latter, yet the disorder died away with hardly any rain, and a very moderate degree of cold.  Its virulence may be said to have expired on the 23d, 24th, 25th, and 26th of October.  The succeeding deaths were mostly of those long sick.  Few persons took the disorder afterwards.  Those days were nearly as warm as many of the most fatal ones, in the middle stage of the complaint, the thermometer being at 60, 59, 71, and 72.  To account for this satisfactorily is above our feeble powers.  In fact, the whole of the disorder, from its first appearance to its final close, has set human wisdom and calculation at defiance.

The idea held up in the preceding paragraph, has been controverted by many; and as the extinction of malignant disorders, generated in summer or the early part of fall, has been universally ascribed to the severe cold and heavy rains of the close of the fall, or the winter, it is asserted that ours must have shared the same fate.  It therefore becomes necessary to state the reasons for the contrary opinion.

The extinction of these disorders, according to the generally-received idea on this subject, arises from cold, or rain, or both together.  If from the former, how shall we account for a greater mortality in September, than in August, whereas the degree of heat was considerably abated?  How shall we account for a greater mortality in the first part of October than in September, although the heat was still abating?  If rain be the efficient cause of arresting the disorder, as is supposed by those who attribute its declension to the rain on the evening of the 15th of October, how shall we account for the inefficacy of a constant rain during the whole terrible twelfth of October, when one hundred and eleven souls were summoned out of this world, and a hundred and four the day following?  To make the matter more plain, I request the reader's attention to the following statement:--

at 3 P.M.
Sept. 19 70 61 SW fair.
Sept. 20 69 67 SE hazy.
Sept. 21 78 57   fair.
Sept. 22 83 76   fair.
Oct. 10 74 93 NW fair.
Oct. 11 74 119 W fair.
Oct. 12 64 111 NW rain.
Oct. 13 69 104 NW fair.
Oct. 23 60 54 W fair.
Oct. 24 59 38 NW fair.
Oct. 25 71 35 S fair, high wind.
Oct. 26 72 23 SW cloudy.

An examination of this table, by any man unbiased by the received opinion, will, I think, convince him of the justice of the hypothesis which I have advanced -- that the increase or abatement of the violence of the disorder, depended on other causes than the degrees of heat, cold, rainy or dry weather.  Here is the most palpable proof.  The average of the thermometer, the four first quoted days, was 75° -- the average of the deaths 65.5.  The second four days, the thermometer averaged 70.25, although the frightful average of deaths was, 106.75.  And on the last four days, the thermometer averaged 65.5, whereas the deaths were only 37.5....

I here annex the weekly average of the thermometer and of the deaths, from the first of August to the 7th of November, for the reader's inspection.

  Average of
Average of
Aug. 1 to 7,
Aug. 8 to 14,
Aug. 15 to 21,
Aug. 22 to 28,
Aug. [29] to 31,
Sept. 1 to 7,
Sept. 8 to 14,
Sept. 15 to 21,
Sept. 22 to 28,
Sept. 29 and 30,
Oct. 1 to 7,
Oct. 8 to 14,
Oct. 15 to 21,
Oct. 22 to 28,
Oct. 29 to 31,
Nov. 1 to 7.

...Let any advocate of the theory of cold and rain, compare the first week in September with the second week in October....  I can only answer, that an inveterate prejudice too often clouds the reason, and renders it impossible to see the truth, however evident.

In opposition to what I have advanced, it has been observed, that the unfavourable effects of very sultry days were felt for several succeeding ones.  This is a weak resource, as will appear from examining the table....

I hope, therefore, the reader will acknowledge, that the Great Disposer of winds and rains, took his own time, and without the means, either moral or physical, on which we placed our chief reliance, to rescue the remnant of us from destruction.

Chap. XV.  Origin of the Disorder.

This disorder has most unquestionably been imported from the West Indies.  As yet, however, owing to various obvious reasons, it is difficult to fix, with absolute precision, on the vessel or vessels, (for it is very probable it came in several, from the different infected islands) by which it was introduced.  That it is an imported disorder, rests on the following reasons, each of which, singly, justifies the theory, but all collectively, establish it to the satisfaction of every candid and reasonable man.

1st. The yellow fever existed in several of the West India islands a long time before its appearance here.

2nd. Various vessels from those islands arrived here in July.

3d. Scarcely any precautions were used to guard against the disorder.

4th. A respectable citizen of Philadelphia, supercargo of one of our vessels, saw, in July, six or seven people sick of this fever on board a brig at Cape François bound for our port.

5th. A vessel from Cape François, which arrived here in July, lost several of her people with this fever, on her passage.

6th. A person from Cape François, died of this fever at Marcus Hook--and another at Chester.

7th. The vessels in which those persons arrived, and which were infected with the effluvia of the sick and dead, came freely to our wharves, and particularly to that very one where the disorder made its first appearance.

8th. Persons sick of the yellow fever have been landed in our city from vessels arrived from the West Indies.

9th. Dead bodies have been seen deposited secretly on board some of those vessels.

10th. There is the strongest reason to believe, that the beds and bedding of the sick and dead were not destroyed, but, on the contrary, brought into our city.

11th. This disorder had every characteristic symptom that marked it on former occasions, when its importation was unquestioned.

Of all the reasons advanced to support the opinion of its having been generated here, the only one that has even the appearance of plausibility, viz. the influence of a tropical season, such as we had last summer, is unanswerably refuted by the concurring testimony of [several physicians], who, in the most unequivocal manner, have declared that it does not depend on the weather.
"It does not appear, from the most accurate observations of the variations of the weather, or any difference of the seasons, which I have been able to make for several years past, that this fever is any way caused, or much influenced by them; for I have seen it at all times, and in all seasons, in the coolest, as well as in the hottest time of the year." ([Dr. William] Hillary [Observations] on ... Diseases in Barbadoes [1759], page 146.)

"This fever does not seem to take its origin from any particular constitution of the weather, independent of infectious miasmata, as Dr. Warren has formerly well observed; for within these twenty-five years, it has been only four times epidemical in this town, namely in the autumns of the years 1732, 39, 45, and 48, though none of those years, (excepting that of 1739, whose summer and autumn were remarkably rainy) were either warmer or more rainy, (and some of them less so) than the summers and autumns were in several other years, in which we had not one instance of nay one seized with this fever:  which is contrary to what would have happened, if particular constitutions of the weather, were productive of it, without infectious miasmata." ([John] Lining, Essays and observations, political and literary, vol. II. page 406.)...

Go to:
  • "Procuring the Small Pox," selected communications on the method of inoculation, from the Philosophical Transactions of the Royal Society of London (1714-1723);
  • An Inquiry into the Causes and Effects of the Variolae Vaccinae.... (1798) by Edward Jenner (1749-1843); and
  • a letter addressed to "My beloved Sister" (September 25, 1793) written by Margaret (Hill) Morris (1737-1816);
  • "An Account of the Bilious Remitting Yellow Fever, as it Appeared in Philadelphia, in the Year 1793," in Vol. III, Medical Inquiries and Observations, 4th ed. (1815) by Dr. Benjamin Rush (1746-1813);
  • An Enquiry into, and Observations Upon the Causes and Effects of the Epidemic Disease Which raged in Philadelphia from the month of August till towards the middle of December 1793 (1794) by Dr. Jean Devèze (1753-1829); and
  • "Yellow Fever," in Vol. XV, The International Cyclopedia (1898).
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