Yellow Fever in the Late Eighteenth Century: Benjamin Rush's Philadelphia
Benjamin Rush. Observations upon the Origin of the Malignant Bilious, or Yellow Fever in Philadelphia, and on the Means of Preventing it. Philadelphia: Printed by Budd and Bartram, for Thomas Dobson, at the stone house, no 41, South Second Street, 1799. DK Bailey Collection, Rare and Distinctive Collections, CU Boulder Libraries.
Benjamin Rush was an American physician and revolutionary politician in the late eighteenth century, who carried significant influence within American medicine and public health circles (Yazawa 2009, 1). He is especially well known for his involvement during Philadelphia’s yellow fever epidemic during the year 1793, where it claimed up to 5,000 lives and was surrounded by multiple controversies regarding its causative agents and clinical treatments.
Of his works, the Observations upon the Origin of Malignant Bilious, or Yellow Fever in Philadelphia, and on the Means of Preventing it, is an attempt by Dr. Rush to provide clarity for some of these variances and can be considered an opposition against his peers within the College of Physicians of Philadelphia who published their own findings on the disease in 1798. Given Rush was a former founding member of this college, his ideas on the topics of fevers and their treatments carried great influence, but were also the reason for the stark criticism drawn from his fellow physicians (Yazawa 2009, 3).
Both works were produced by the same printing and publishing company run by Thomas Dobson in Philadelphia, and display similar typography and printing layouts. One noticeable element from this period’s typography style is the use of the “long s” that may resemble a lowercase “f” with the crossbar going only halfway through the vertical portion of the letter (Kratz 2021).
Rush’s principal observation was his claim that the fevered disease was domestic to Philadelphia, instead of a more accepted theory that it was “imported” from the West Indies via incoming ships (Rush 1799, 3). He emphasized the consequences of this stance as an “unwelcome truth” and one, if not taken seriously, would undo the city’s eminence as a political and economic power (Rush, 28). According to his theory, the causes of yellow fever are a product of “putrid vegetable and animal exhalations” that flourish in hot climates or seasons, and lists eight particular sources within the city that contribute to its pestilence (Figures 2 and 3).
In the following pages, Rush explains why these sources haven’t caused outbreaks in the past, and largely attributes this new outbreak to the increased “inflammatory constitution of the air” in combination with putrid exhalations, and “exciting causes” (Rush, 6). Much of his clinical reasoning was influenced by the Greek physician Hippocrates as well as Dr. Sydenham, another 18th century physician who was considered an expert on fevers (Rush 1799, 7; Kopperman 2004, 556; Snowden 2019, 17-20). This included his rationale for how to categorize yellow fever and to treat it, the treatments consisting of overzealous bloodletting and a strict diet of vegetables, broth, and salted meats. Rush believed these were the remedies to combat an inflammatory disease such as yellow fever, however, other physicians such as William Cullen or Thomas Sydenham, believed yellow fever belonged in alternate categories than Rush’s, such as typhus or debilitating fevers; each classification rendering different treatments (Kopperman 2004, 560).
Many of these ideas and observations by Rush attempted to refute his colleagues,’ however, there were particular concepts and methods that both parties agreed needed attending. In the article “Facts and Observations Relative to the Nature and Origin of the Pestilential Fever, Which Prevailed in This City, in 1793, 1797, and 1798,” written by the College of Physicians of Philadelphia a year prior, the authors explain their shared methods of addressing the outbreak by screening and cleaning each ship for diseases, ventilating every vessel in order to combat the “foul air”, the need for more sanitation in the streets and water pumps, and enforced quarantine measures (Rush 1799, 21; College of Physicians 1798, 7-9).
These public health concepts were included and discussed in Rush’s book and, while each text expresses strong viewpoints on the different origins and causes of the disease, they both appear to argue for the same goal of improving the city’s health and a duty to serve the public.
- Jake Clark, Fall 22
Benjamin Rush’s Observations upon the Origin of the Malignant Bilious, or Yellow Fever in Philadelphia, and on the Mean of Preventing it, printed in 1799 by Budd and Bartram in Philadelphia, explored the means by which yellow fever appeared, spread, and could be treated. Rush studied medicine at the University of Edinburgh, the premier medical institution of his time, before returning to the states (Yazawa, Melvin, “Rush, Benjamin”). He quickly became Philadelphia’s leading physician, working tirelessly treating the yellow fever outbreak of 1793, nearly dying of the disease himself (Yazawa, Melvin. “Rush, Benjamin”). He summarized everything he learned during this period in his book which focuses most on the nature of contagion, based on Hippocrates’ idea of miasma, and how to rid cities of impurities that can lead to disease (Rush, 1799). The book was printed at The Stone House in Philadelphia at no. 41 South Second St. Made on a printing press, the book was likely printed in large quantities and distributed to those who were educated enough to read its contents.
While the information in Rush’s book was mostly supported in his time, it has roots in ancient Hippocratic practices and ineffective treatments, something important to remember when reading his work. Preventative measures mentioned by Rush include cleaning of seaports, gutters and sewers with the general idea being that the removal of “filth” stops the spread of disease and idea shared by early physicians like Galen and Hippocrates (Rush, 1799).
We know today that the disease is spread by infected mosquitos, but Rush believed yellow fever was a miasmic disease spread by “putrefying filth’ like rotting vegetable matter (Harvard Library, “The Yellow Fever Epidemic in Philadelphia, 1793”). Published in the same printing house as Rush’s work, “The Proceedings of the College of Physicians of Philadelphia, Relative to the Prevention of the introduction and Spreading of Contagious Diseases,” a publication by the College of Physicians of Philadelphia, explores the spread of a contagious fever similar to yellow fever. Unlike Rush the physicians hypothesized that disease spread through the transport of slaves from port to port and thus through human contact (Harvard Library, “Proceedings of the College of Physicians of Philadelphia, Relative to the Prevention of the Introduction and Spreading of Contagious Diseases”). Their analysis is far closer to modern germ theory than Rush’s work, published a year later which lead to dissent between the two parties and their supporters.
Rush’s treatments methods were also quite controversial. As a doctor, Rush’s reputation was seemingly immaculate. He deeply cared for his patients and was incredibly devoted to his work (North, 2004). Because of this reputation, his bleeding and purging technique used to treat yellow fever shocked many of his supporters, striking outrage in much of the medical community as his “depletion therapy” seemed particularly out of character for the doctor (North, 2004). The College disagreed with Rush in this area too and did not back his bloodletting treatments.
At first glance Benjamin Rush is a beloved genius, respected by his community and peers, but looking at the work of the College of Physicians of Philadelphia you see Rush in a new light. His analysis of the yellow fever is rooted in more ancient beliefs than those of the college, and his treatments were condemned by his peers as well. Rush’s work didn’t exist in a vacuum, and remembering this allows for a greater understanding of public health at the time by comparing his ideas to those around him. It can be assumed Rush had the best intentions with his publication, trying to educate the public on the methods he believed would help stop the spread of the disease. By publishing, the populace and the educated elite alike had the resources and information Rush believed they needed to slow the massive public health crisis that was the yellow fever outbreak of 1793.
- Vivienne Airhart, Fall '22
Benjamin Rush was an important figure of the era and an instrumental part of the Revolution and the institution of the Early Republic. He was a doctor who held many important posts, and was widely respected as an expert, as he was in contact with some of the leading figures in medical science in Europe, as well as having a keen eye for observation and detail. He was the Surgeon General of the Continental Army as well as Washington’s personal physician. His work on the Yellow Fever provided excellent and reliable information on the disease itself, as well as how to combat it (ODNB).
The book, first printed in Philadelphia in 1799, was based on his handwritten notes over the years in question. It is short, concise and well organized – structured for
the most part on the style of 'Frequently Asked Questions' that is popular today. It is very interesting to note that Rush had to battle not only the disease, but a panicked public that was not interested in listening to sober evidence. He begins his book by explaining that he tried for over six years to convince the people of Philadelphia that the disease was not brought in by peoples from abroad.
It is worth noting a few of his particular conclusions. He arrived at the conclusion that the disease was caused not by contagion, but by purification. It was connected to the heat and filthy conditions of the city. Nature and cleanliness had much to do with its eradication as when he noted “the power of heavy rains to destroy the fever shows that it does not spread by contagion.” (Rush, 1799, 16). His recommendations for combatting the disease are also quite valuable and have been incorporated as normal governmental standards today.
Here is what he said are the causes of Yellow Fever:
1. “filthy matters in a highly concentrated state acted upon by the heat of the sun” (4)
2. Foul air of ships
3. Common sewers
4. Gutters
5. Dirty cellars and yards
6. Privies
7. Putrefying masses of matter lying in neighborhoods
8. Impure pump water
We now know, with the aid of a couple centuries of scientific discovery in virology and blood borne diseases, that yellow fever is caused by mosquitoes. While Rush did not actually specify the mosquito as the cause, his list of causes and recommendations amount to destroying the mosquitoes’ breeding grounds. We hear similar recommendations from the CDC and local authorities today about curtailing the spread of West Nile Virus.
It is very interesting to read a companion document, which charted the decisions made, and actions taken, by the city government of Philadelphia which paint the picture of a government being overwhelmed by an epidemic – in the same way that COVID overwhelmed our own resources. In the “Minutes of the Proceedings...” the city council recorded some interesting developments and their responses that show the devastation of the fever in 1793.
Here are a few examples:
Sep 24: request for “frequent applications made to them for burial of the dead, and they may be furnished with a horse and cart” to remove the bodies.
Oct 12: a request for the appointment of a special committee “to prevent the introduction and spreading of infectious diseases”
Oct 16: cold temperatures and heavy rains reduced significantly the number of cases
In addition, there are two recurring themes in the committee business that are worthy of note. One is the constant scrambling for resources – new hospitals were created by converting homes into places for the sick, monies raised for the feeding and care of the sick, food and clothes raised for the relief of the many newly orphaned children in the city as well as places to store and bury the dead. The other interesting theme is the difficulty the city had in trying to keep medical professionals on hand. The needed numbers of doctors and nurses were very difficult to attain, and those they had fled the city. The committee sent far and wide, offering increased salaries in trying to attract medical professionals.
The audience for Rush’s book, as he wrote in the title page, was the people of Philadelphia. It was mainly targeted at civic leaders as a fact book to guide their actions in fighting the fever. But it also had recommendations that citizens could follow. Rush’s clear headed and detailed observations helped to pave the way toward city sanitation efforts and did much to combat the fear and emotional targeting of “foreigners” and “divine punishment” as causes, or scapegoats, for the epidemic. It provides sober and accurate measures that can be taken by communities to limit the possibility of epidemics in the future and encourages civic leaders to look honesty at their own need for improvement.
- Anonmymous, Fall '22