Features appear in each issue of Pennsylvania Heritage showcasing a variety of subjects from various periods and geographic locations in Pennsylvania.

On August 5, 1793, Dr. Benjamin Rush was summoned to the waterfront residence of fellow physician Hugh Hodge, whose daughter had recently taken ill. For days Rush had been treating Philadelphians for a serious outbreak of influenza and had assumed that this was yet another case. But when he found the small girl on her deathbed, gasping for breath and vomiting black bile, Rush instinctively knew that he would soon be confronted with a much more dangerous sickness.

Within a month, the fever had reached epidemic propor­tions. Through glazed eyes, yellowing complexions, and frightening delirium, stalwart Philadelphians tried to conduct business as usual, believing that this strange sickness would soon pass. By August 25, however, the fever had claimed dozens of victims and there was no relief in sight. Panic ensued. Shopkeep­ers closed their doors and many businesses withered away. The external commerce on which almost everything else depended could not continue because other ports, fearing infection, refused to receive goods shipped from Philadelphia. All government business came to a standstill. Those who could afford it fled the city, seeking refuge in the countryside. Those who could not cowered inside their homes, venturing out only as necessary to secure food and water. Philadelphia, the federal capital, had become a ghost town overcome by death and disease. The only move­ment on the streets was that of the African American carters who exhorted the living to “Bring out your dead!” for burial outside the city limits.

Philadelphia’s yellow fever epidemic of 1793 was one of the most devastating events in the city’s history. Claiming the lives of over four thousand residents – nearly ten percent of the urban population – the epidemic ignited widespread fear and tested the social fabric of the city. But it also pro­duced a hero, Dr. Benjamin Rush, as well as several remarkable inspirational role models in Philadelphia’s African American community. The efforts of these citizens gave renewed meaning to the spirit of brotherly love upon which Philadelphia had been founded.

Yellow fever was an infectious tropical disease transmitted by the Aedes Aegupti mosquito. Unknown to medical science during the eighteenth century, the female mosquito could bite a victim of the plague and transmit the infection to another person every three days or as often as she fed. Often called “vomito negro” because of the black blood vomited by the sufferer, the disease had an incubation period of eight to twelve days and was characterized by violent fevers, internal bleeding and a yellowish tint­ing of the complexion caused by jaundice. During the early summer of 1793 the fever had been raging in the West Indies. It was probably carried to Phil­adelphia during July when vessels from Santo Domingo were allowed to come into the port without sanitary inspection or quarantine. Rush was the first to make this assumption.

One of the youngest signers of the Declaration of Indepen­dence at the age of thirty, Benjamin Rush was by 1793 one of the most respected citizens of Philadelphia. He was well established as both a practicing physician and professor of chemistry at the University of Pennsylvania. He had witnessed a bout of the yellow fever only once before, in 1762, although that outbreak was confined to a single waterfront street and resulted in a limited death toll. Based on this experience, Rush insisted that the source was putrescent refuse, specifically the “damaged cargo of coffee” that had been dumped on the Arch Street wharf by the Amelia, a sloop out of Santo Domingo. “Contagion,” he believed, was caused by the “circulation of noxious matter from this refuse into the air and subsequent inhalation.”

To prevent the transmission of the fever, Rush recom­mended that Philadelphians hold handkerchiefs soaked with camphor oil or vinegar to their nostrils as they moved about the streets. Rush thought these vapors would counter the infectious odor of the yellow fever. But some of his colleagues disagreed with this assessment.Choosing to satisfy a nativist impulse, these physicians contended that the disease was associated with the hundreds of French and West Indian refugees that relocated in Philadelphia after the Black uprising in Santo Domingo. Others intuitively felt that the uncommonly large numbers of mosquitos which infested the city that summer had something to do with the disease. Whatever their opinion, all of the city’s physicians somberly as­sembled in the hall of the American Philosophical Society on August 25 to “confer upon the treatment of the existing malignant fever.” However, medical opinions remained divided.

Benjamin Rush based his arguments on a previous case of the epidemic that occurred in Virginia in 1741. All the victims of this plague shared a common symptom: their abdominal viscera were filled with blood. The most effective cure was found to be a thorough bleeding and purging of the body’s humors. Accordingly, Rush insisted that victims of the current epidemic be bled extensively so that “four-fifths of the total volume of blood or twenty pounds be drawn away.” Simultaneously, the patient should be purged with “high dosages of calomel and jalap.” This practice of heroic bleeding and purging was consistent with Rush’s belief that the human body contained about twice as much blood as it actually does. While he experienced some limited success with these measures, history has since shown that Rush actually weakened his patients and may have even hastened their demise.

In addition to Rush’s therapy, more conservative treatments also existed. Dr. Edward Stevens, a native of the West Indies, induced limited bleeding and adminis­tered mild dosages of medicinal barks and restorative liquids to his patients, including Secre­tary of the Treasury Alexander Hamilton, who eventually recovered. Dr. David Nassy, a French refugee who was more fully acquainted with tropical fevers, claimed the greatest success of any Philadelphia physician. Instead of bleeding his patients, Nassy treated them strictly with medicinal herbs, cool liquids, and cool baths. His treatment worked remarkably well. Between August 28 and October 1, only nineteen of his one hundred and seventeen victims died of the epidemic. Nevertheless, Rush was the city’s most prominent physician and his methods of treatment tended to prevail. If nothing else, the eminent physician was determined to remain in Philadelphia because he felt morally obliged to treat those in need of medical attention. Government officials did not share Rush’s resolve.

When the fever struck Philadelphia in August, Congress was not in session. The Supreme Court met for a single day and adjourned without trying a single case of importance. Pres. George Washington’s cabinet officials remained in the city, finding themselves “blockaded by the disorder.” They realized their presence was one of the few things that gave Philadel­phians “hope for relief.” But by mid-September the plague had driven the executive branch out of the city too. According to Secretary of State Thomas Jefferson who was planning his departure for Virginia, “everybody who can is flying from the city. Alex­ander Hamilton (Secretary of the Treasury) has fallen ill, General Knox (Secretary of War) has already left for Mass­achusetts, and President Washington has set out for Mount Vernon. When and where we shall reassemble will depend on the course of this malady.” They left with good reason.

On a typical August day in Philadelphia there would have been three to five burials. On August 24 there were seven­teen; four days later there were twenty-two; and on August 29, the number rose to twenty­-four. By mid-September the death rate soared to nearly seventy mortalities a day. Panic erupted and led to a rapid deterioration of the city’s social fabric. The crime rate soared dangerously high as the idle and the juvenile delinquent resorted to arson to plunder the ruins of a mansion or shop. The back streets and alleys became death traps for the poor who could not afford to flee the city as could most of their wealthier neighbors. Husbands left their stricken wives of many years, parents abandoned their sick children, and masters thrust their infected servants into the streets. Newspaper editor Mathew Carey who chronicled the epidemic wrote 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.”

The height of the yellow fever epidemic occurred on October 11, 1793, the day the terrorizing fever claimed the lives of one hundred and nineteen victims. By that date nearly twenty thousand of Philadelphia’s forty-four thousand inhabitants had fled the city along with the federal, state, and municipal govern­ments. “You cannot imagine the situation of this city,” wrote one desperate soul. “How deplorable it continues to be by the removal of its inhabitants into the country­side and by the destructive fever which now prevails. Death and dying all around us and no relief in sight!” Only poor whites, free Blacks, and a few of the courageous affluent remained to keep company with the afflicted, hoping to alleviate their miseries.

Since the apparatus of municipal government had abandoned the city, Thomas Clarkson, the sixty year old mayor of Philadelphia functioned through an extralegal committee consist­ing of self-appointed leaders. Among them were Rush, aspiring financier Stephen Girard, and John Todd, a promising young Quaker lawyer. These three risked their lives for the welfare of those who had contracted the disease.

Benjamin Rush placed himself in the greatest danger. Working day and night with a minimum of sleep he was often waylaid by families of sufferers while making his rounds in the city’s lower class wards. He imperiled his own health by treating as many as one hundred and fifty patients ma single day. He was forced to work in filthy, dangerous conditions because Pennsylva­nia Hospital refused to admit plague victims in an effort to protect their other patients. The only depository made available to sufferers was Rickett’s circus grounds on the outskirts of the city. Stephen Girard lessened Rush’s burden in mid-September by helping to organize an emergency hospital at Bush Hill, the one­time country estate of the famous Philadelphia lawyer, Andrew Hamilton.

At the age of forty-three, Girard was not yet well known as the eminent banker and philanthropist he would soon become. Instead, he was a Front Street grocer with genuine compassion for the less fortunate. Predictably, he took charge of the administra­tion of the makeshift hospital at Bush Hill, as well as under­taking the maintenance of the rooms and the general care of the victims who had nowhere else to go and no one to care for them. His careful supervi­sion resulted in a clean, airy hospital with rigidly enforced procedures: bowls of vinegar were placed in patients’ rooms to discourage the mosquitos, doctors were required to rinse their hands in a basin of vinegar before examining a victim, and visitation was carefully controlled.

John Todd, a promising young lawyer and a member of the bench of the Philadel­phia Common Pleas, the Pennsylvania State Supreme Court, and the United States Supreme Court, remained in the city to draw up the last will and testaments of the dying. Todd lost both of his parents and his youngest son to the yellow fever before succumb­ing to the disease himself in late October. Only his eldest son, Payne, and his wife Dolley – who later married James Madison, destined to become the fourth president of the United States – escaped the fever. Despite the herculean efforts of these three, more help was needed if Philadel­phia was to survive the epidemic.

Physicians and city authori­ties found it extremely difficult to tend to the large numbers of the sick. It became impossible to bury the dead because most nurses, carters, and grave diggers feared the disease, and refused to be near the sick, dying, or deceased. Rush was so overwhelmed by the situation that he appealed to the city’s African American community for help. Con­vinced that the malignant fever “passes by people of color,” he attempted to enlist the support of the Rev. Richard Allen, founder of the African American Mother Bethel Methodist Church and the most influential Black leader in the city. While Rush insisted that the Black commu­nity was “under a divine obligation to attend the sick as nurses, gravediggers, and carters” because. God had exempted them from the plague, Philadelphia’s African Americans had more than ample reason to ignore his plea.

Many of the Caucasian victims who lay dying had strongly opposed the establish­ment of an African Church in the city. They viewed such a church as a threat to the dominance of the existing Episcopal and Methodist congregations in Philadelphia. More disturbing was the recent attempt by a segment of Philadelphia’s white commu­nity to overturn a state law requiring the manumission of any slave brought into Pennsylvania within six months’ time. However, Richard Allen, along with Absalom Jones, the first ordained Black Episcopal priest in America, convinced the African American commu­nity that the yellow fever was a God-sent opportunity to prove their courage and worth as human beings and to demonstrate that Blacks could remove bitterness and anger from their hearts, possibly even dissolving white racism in the city.

Meeting with the Free African Society of Philadelphia on September 5, the Black clergyman insisted that “God knows the hearts of all men” and that the “meek and humble Jesus, the great pattern of humanity and every other virtue that can adorn and dignify man, hath commanded us to love our enemies, to do good to them that hate and despitefully use us.” Their argument was compelling enough to convince their followers who volunteered as nurses, carters, and grave diggers. Even Allen and Jones served as auxiliary doctors for Rush, bleeding patients and administering purges. Unfor­tunately, Rush’s claim that African Americans were immune to the disease proved incorrect-and fatal. By early October about two hundred and forty Blacks had died of the yellow fever. Nevertheless, Philadelphia’s African American community contin­ued to help the sick and the dying, convinced it was its “duty to do all the good (they) could to (their) fellow mortals.”

The first frost in late October slowed the death rates and many Philadelphians began to return to their city dwellings. Against the advice of his closest advisors who worried that his “indifference about danger” might make him risk his own health, President Washington decided to ride into the city on Novem­ber 10. To those who lined the streets and alleys, Washing­ton’s return signaled the end of the epidemic. Despite the fact that the air was fresh and cool for the first time in months, the president decided that it was best to take up residence in Germantown, six miles northwest of the city, until Congress reconvened in early December.

Ironically, President Washington established his Germantown headquarters in the elegant mansion of Col. David Franks, where fifteen years earlier the British Commander-in-Chief, Sir William Howe, had received the shocking news that the Continental Army was advancing on his troops at the Battle of Germantown. Washington chose this house because it was “more commo­dious for myself and the entertainment of company,” particularly his cabinet members whose attendance was requested on four separate occasions during the last two weeks of November. He summoned his officials while preparing his address to Congress.

After the yellow fever crisis of 1793 passed, city officials took steps to improve sanita­tion by cleaning the streets of their usual filth. These efforts proved to be unsatisfactory, for garbage continued to accumulate in the back streets and alleys, animals still roamed freely throughout the city, the collection of human excrement remained sporadic at best, and the wells from which people drank were often polluted. Not surprisingly, yellow fever returned to Philadelphia in 1796 and 1797, although not with the devasta­tion of the 1793 epidemic. Nevertheless, each bout with the dreaded disease stymied physicians and terrified their patients. For those who survived the plague outbreaks, daily affairs continued, but not without a new apprecia­tion of good health and, ultimately, a renewed reverence for life itself.


Quotes About the Yellow Fever Epidemic of 1793

Dear, dear Doctor, Do come to see me – I am fatigued almost to death – my precious Daughter is very, very weak – What can be the reason – no Citizen Doctor, or other Gent comes to see us. – James Read

I treat my patients successfully by bloodletting, and copious purging with calomel and jalep – and I advise you, my good friends, to use the same remedies! Bleed and purge all Kensington! – Dr. Benjamin Rush

I do not know when our misfortunes will end. I am off now to the hospital where so many sick are received daily that my presence is constantly demanded. I have devoted all my time and my person, as well as my little fortune to the relief of my fellow citizens. – Stephen Girard

The sick, the dying, and the dead were indiscriminately mingled together. The ordure and other evacuations of the sick, were allowed to remain in the most offensive state imaginable. Not the smallest appearance of order or regularity existed. It was, in fact, a great human slaughter-house, where numerous victims were immolated at the altar of riot and intemperance. … there were to be found many illustrious instances of men and women, some in the middle, others in the lower spheres of life, who, in the excercises of the duties of humanity, exposed themselves to dangers, which terrified men, who have hundreds of times faced death without fear, in the field of battle. – Mathew Carey

The distress of these times cannot be comprehended, except by those who was present and could know the real situation of the inhabitants. Fear seemed to absorb all the finer feelings of the heart. – Charles Willson Peale

It was my wish to have continued there longer, but as Mrs. Washington was unwilling to leave me surrounded by the malignant fever wch. prevailed, I could not think of hazarding her and the Children any longer by my continuance in the City house in which we lived being, in a manner, blockaded, by the disorder and was becoming every day more and more fatal. – George Washington

…one of the carters in the service of the committee Reports, that in the performance of his duty he heard the cry of a person in great distress, the neighbours informed him, that the family had been ill some days – and that being afraid of the disease no one had ventured to examine the house; he cheerfully undertook the benevolent task, went up stairs and to his surprise found the father dead, who had been lying on the floor for some days, two children near him also dead, the mother in labour; he tarried with her, she was delivered while he was there, and in a short time both she and her infant expired! he came to the City Hall, took coffins and buried them all. – Caleb Lownes

A large City with the Houses shut up & the streets empty except the french Sailors, People of St. Domingo of all Colours with their heads tied a few Citizens whom you do not know posting along with Sponges in their noses & the Herse Constantly passing exhibits such a melancholly picture that I never left Phila. with so much pleasure as yesterday nor never found Such Pleasure in the Country as I do today. – William Lewis, Esq.

The same melancholy scene of devastation continues! Whoever are the survivors will be shocked at the altered appearance of the city. – Deborah Norris Logan


For Further Reading

Allen, Richard, and Absalom Jones. A Narrative of the Proceedings of the Black People, During the Awful Calamity in Philadelphia in the Year 1793. Philadelphia: N. P., 1794.

Carey, Matthew. A Short Account of the Malignant Fever. Philadelphia, 1794.

Nash, Gary B. Forging Free­dom: The Formation of Philadelphia’s Black Commu­nity, 1720-1840. Cambridge: Harvard University Press, 1988.

Powell, J. H. Bring Out Your Dead: The Great Plague of Yellow Fever in Philadelphia in 1793. Philadelphia: University of Pennsylvania Press, 1949.

Rush, Benjamin. An Account of the Bilious Yellow Fever. Philadelphia: N. P., 1799.

Weigley, Russell F. Philadelphia: A 300 Year History. New York: Random House, 1982.

Williams, Guy. The Age of Agony, The Art of Healing. Chicago: Academy Chicago Publishers, 1986.


William C. Kashatus III is a regular contributor to this magazine. A doctoral candidate in the history of education at the University of Pennsylvania, he is author of Historic Philadel­phia: The City, Symbols, and Patriots, 1681-1800, published by the University Press of America in 1992 (see “Bookshelf” in the fall 1982 edition).