Few disease outbreaks in the history of early America proved as tragic as the Philadelphia Yellow Fever epidemic of summer, 1793, and fewer still have lingered longer in historical memory. A bustling center of international trade and commerce that welcomed people, goods, and pathogens from around the world, Philadelphians were well-acquainted with infectious disease prior to the 1793 outbreak. The city had even known sporadic Yellow Fever outbreaks at various points throughout the eighteenth century. But that feared disease returned to Philadelphia with a vengeance in summer, 1793, via West Indian trading vessels carrying French refugees fleeing the island of Santo Domingo in light of long-standing civil unrest and slave rebellion. Over two thousand refugees flooded into Philadelphia, some of whom had succumbed to Yellow Fever at sea. With these trading vessels came the worst infectious disease outbreak the city had hitherto experienced.
Cases of the “pestilence,” as some referred to Yellow Fever, spread rapidly from residential areas surrounding Philadelphia’s port to other districts throughout the city. Though residents of impoverished quarters seemed particularly vulnerable to infection, none could escape the disease’s terror. As word spread that Yellow Fever had returned to Philadelphia, many affluent residents fled for their country estates or homes of relatives. Commercial and governmental operations ground to a halt. Those who could not escape the city witnessed grisly scenes of sickness and death round seemingly every street corner. Yellow Fever claimed 5,000 lives, or ten percent of Philadelphia’s population, between August 1 and November 9, 1793.
Yellow Fever is a virus transmitted between humans by mosquitoes. This method of transmission was unknown in the eighteenth century, however; the role of mosquitoes in carrying the disease was first proposed in 1881, and viruses were not discovered until much later. The germ theory of the spread of infectious diseases remained unproven in the last years of the eighteenth century, which hampered consideration of possible causes of the disease. Proper prevention, diagnosis, and treatment of Yellow Fever emerged as issues of frantic and often contentious public debate in Philadelphia and across the young United States. Philadelphia was the center of early-national American economic, political, and cultural life. The debilitation of the city due to disease posed potentially dire consequences for the region and, indeed, the entire country. A sense of mystery surrounding the disease’s origin and transmission only deepened the public’s terror.
Commentators during and after the Yellow Fever epidemic observed that the episode brought out the best and worst in Philadelphia’s residents, as municipal leaders, prominent physicians, and everyday residents struggled to understand the cause of Yellow Fever, to manage the outbreak, and to escape its brutal path. While none succeeded in stamping out the disease, historical accounts of the city’s lively response to the fever reveal much about the civic, cultural, and intellectual workings of early America’s largest and most prosperous city.
The lesson presented here – What the Doctor Ordered: Dr. Benjamin Rush Responds to Yellow Fever – is best implemented at the end of a lengthier unit on the Yellow Fever epidemic of 1793, after students have acquired sufficient contextual background to pursue independent work with primary sources related to the epidemic.
Reports on the yellow fever epidemic, 1793
A Spotlight on a Primary Source by Unknown Correspondent
Between August 1 and November 9, 1793, approximately 11,000 people contracted yellow fever in the US capital of Philadelphia. Of that number, 5,000 people, 10 percent of the city’s population, died. The disease gets its name from the jaundiced eyes and skin of the victims. Other symptoms include fever, headache, and "black vomit" caused by bleeding into the stomach. At the time, it was thought that yellow fever was caused by rotting vegetable matter, and it was believed to be contagious; the disease is actually spread by mosquitos.
The epidemic created panic in the capital, causing 17,000 people, including President Washington and other members of the federal government, to flee to the countryside. This document, from the papers of Secretary of War Henry Knox, contains two reports written during the peak of the epidemic in the first few weeks of October. Knox had moved his office to Montgomery County before taking his family back to Boston. The document is possibly a compilation of accounts Knox’s staff were receiving from elsewhere. One report notes: "The day before yesterday we were witness to what appears to me Shocking – a Coffin was brought to the entrance of Welsh’s alley, where it stayed sometime for the man to die before he was put into the Coffin, Such hurry must burry many alive."
The war department was keeping Knox informed about the situation since Washington and the Cabinet were trying to determine if it was safe for the government to return to Philadelphia in November.
The fever from all that I can learn is more fatal than ever, yesterday a vast number of burials – I do not expect any abatement of the fever before we have rain and high winds – The day before yesterday we were witness to what appears to me Shocking – a Coffin was brought to the entrance of Welsh’s alley, where it stayed sometime for the man to die before he was put into the Coffin, Such hurry must burry many alive.
A transcript is available here.
Questions for Discussion
Read the introduction, examine the image of the letter, and study the excerpt and the transcript. Then apply your knowledge of American history to answer the following questions:
- How did the lack of medical and scientific knowledge about yellow fever contribute to the spread of the disease?
- Using information from the letters, assess the seriousness of the yellow fever epidemic of 1793.
- Compare the reaction of the citizens of Philadelphia in 1793 to reactions of people to one of the recent epidemics and pandemics involving a disease such as: severe acute respiratory syndrome virus (SARS), the Middle East respiratory syndrome coronavirus (MERS), or the Ebola virus.
- Additional Research: Explain the process by which physicians and scientists ultimately discovered the cause of and effective treatment for yellow fever.