An American Plague: The True and Terrifying Story of the Yellow Fever Epidemic of 1793

“Fear, it seemed, was spreading even faster than the disease.” 

When yellow fever starts to spread throughout the city in August, people begin to panic. They notice the death toll going up and no one knows exactly what the cause is. Although the mayor and governor try to take steps to contain the situation, news travels fast through the city’s taverns, markets, and shops, creating fear that temporarily overshadows the disease.

“They heard the church bells tolling, tolling, tolling—and they ran.” 

Whenever people die in Philadelphia, the church bells toll. As the fever grows worse at the end of August, the church bells toll more frequently. The regular tolling helps catalyze a mass exodus from Philadelphia, with estimates putting the number who fled at around 20,000.

“The science of medicine at the end of the eighteenth century still relied a great deal on ancient myths and folk remedies. Because of this, people did not automatically reject the opinion of someone simply because that person wasn’t a trained doctor.” 

In Chapter 3, Murphy introduces one of his main themes in the book: which is the persistence of ancient understandings and cures for illness. During the yellow fever epidemic, the popularity of this line of thinking opens the door for dozens of cures and treatments to be offered, none of which can be scientifically proven to be effective. Ordinary people write in to newspapers recommending a wide range of remedies that are sometimes no different from cures offered by doctors. Since no one had a solid understanding of the disease, almost any treatment could be attempted.

“Mayor Clarkson’s greatest concern was the mounting number of penniless people in Philadelphia. As well-off citizens closed their businesses and fled the city, they left behind thousands of individuals without any source of income. When these people became ill, they had no money to pay for food, medicine, a physician, or a nurse.” 

One of Murphy’s other major themes is the class structure in Philadelphia. When the wealthy and middle classes flee the city, they leave behind a large class of poor people. With everything closing, the impoverished now have no way to make money and are also highly susceptible to getting sick. They therefore become even more vulnerable than they were before the fever struck. Mayor Clarkson is one of the few individuals who stays behind to help them.

“Without Congress to pass laws and appropriate money, the working of the federal government would eventually come to a grinding halt.” 

In September, President Washington and other influential members of the federal government leave the city. A constitutional crisis ensues since Congress is not allowed to convene outside the city limits of the nation’s capital. There is no possible way for Congress to address the situation and help the people left behind in Philadelphia.

“If any group of individuals had reason to ignore the sufferings of their neighbors, the elders of the Free African Society did. Yet they did not hesitate.” 

When Benjamin Rush asks the Free African Society to help with sick patients, they agree without hesitation. Since they have been discriminated against in the past and continue to face racism, they would have been justified in saying no to Rush’s request. However, they rise to the challenge and do a great service for those in need.

“Rush did not happen upon his cure easily or immediately. During the earliest days of the fever Rush had treated patients with great caution. Doctors of that era believed in what was called vis medicatrix naturae, the healing power of nature.” 

The aggressive cure that Benjamin Rush eventually recommends develops over time, representing an extreme form of the era’s medical practices. Most doctors believe that the body will heal itself, so all it needs is some prodding along through various methods. Treatments by 1793 are usually modest and more gentle, but Rush feels he is up against a disease that requires something much more intense. He offers an extreme form of vis medicatrix naturae.

“Rush took any challenge, whether from a disease or from a colleague, as a personal attack to be confronted and conquered.” 

Although Benjamin Rush stays behind to help fever patients, he receives a lot of criticism for his ideas on the disease, as well as his cure. He is a very strong-willed person, so he feels he must publicly defend himself when anything is said against him. For this reason, he makes many enemies, some of whom are prominent and influential people.

“Medicine was in a curious state of transition at the end of the eighteenth century—groping toward more scientific and precise explanations of disease, while still clinging to beliefs hundreds and even thousands of years old that were rooted in mythology and folk tales.” 

Although facets of the medical profession look to the past for cures and understanding the human body, other aspects are showing signs of change. Doctors are beginning to seek science-based explanations for diseases. This trend grows more pronounced over the next century.

“Clarkson and his committee had, in effect, seized control of the government.” 

In September, Mayor Clarkson takes dramatic action and forms a committee to take power over the city. The act is illegal and comes with consequences later, as committee members must pay back the money they spent out of their own pockets. However, Clarkson feels it is necessary as the city is spiraling into chaos and has no functioning government.

“Bush Hill became a pocket of calm and hope, but it could not cure or comfort the entire population of Philadelphia. The city continued to stagger under the invisible invader’s assault.” 

After Mayor Clarkson establishes the committee, he creates subcommittees to address various needs in the city. One group comprised of Stephen Girard and Peter Helm takes control of Bush Hill, the abandoned mansion that has been converted to a hospital. The hospital has few people to help and is in disarray when Girard and Helm volunteer to help. Although they turn it around, Philadelphia has many other problems to confront.

“Such distress upset and frightened him, but it also strengthened his conviction that Philadelphia had brought it all on itself. ‘After such a merry, sinful summer,’ he mused, ‘by the just judgement of God, a most mournful autumn followed.’” 

Reverend J. Henry C. Helmuth represents a deeply religious perspective on the fever. He believes that sinful Philadelphians are entirely at fault for the epidemic. In his view, they have engaged in trivial entertainment and therefore deserve the wrath of God.

“More than just the fever was preying on those left in Philadelphia. The crime rate went up, and there was rioting. Few firsthand accounts make mention of the lawbreaking and violence.” 

While it was not widely reported, Philadelphia has devolved into lawlessness by early October. There is rioting and looting, and some people selfishly use charity money from the committee for themselves. Many landlords turn out jobless tenants who cannot afford to stay.

“Humor might relieve the tension, but only for a few minutes. In time, the reader would look up and see the deserted streets, hear some nearby cry for help. The horror was all around and not likely to go away soon.”

While a newspaper editor uses humor in his paper to ease some of the burden of the situation, it cannot erase the reality of the fever. Laughing about everything may provide temporary relief, but people are still sick and dying. It is impossible for anyone left in the city to avoid.

“The city seemed to be awakening after a long, inescapable nightmare.” 

By late October, the fever is subsiding and many people begin to return to the city. For those who endured the epidemic, they feel as though they are waking up from a bad dream. Everything in the city starts to reopen and order is slowly restored.

“Those returning found their city a changed place. The streets were remarkably clean, for one thing. The trash and garbage had been swept away; dead animals—cat, dogs, bids, and pigs—had been removed. Gone, too, were the beggars and homeless children.” 

When people start coming back to Philadelphia, they see some major changes, most of which revolve around public health. Thanks to the efforts of Mayor Clarkson, the committee, the Free African Society, and others, the city is in much better condition than it had been when people started to leave. One thing nearly everyone agrees on is that the bad smells need to be permanently eliminated. Although it turns out they are not a contributor to the disease, the consensus is that they are bad for public health.

“The Narrative is not just a firsthand account of what the free black community in Philadelphia did for the sick and dying of the city; it is the very first document published in the United States in which leaders of the black community confronted an accuser directly and attempted to articulate the depth of their anger. It is a remarkable essay, tightly argued and organized, passionate and unrelenting.” 

The text written by Absalom Jones and Robert Allen in response to Matthew Carey’s statements about African American nurses in his book is a historic document. It shows the growing empowerment of the African American community, as influential members of the Free African Society directly challenge Carey’s comments. It is also strongly written and forces Carey to respond.

“So life went on in Philadelphia, in many ways changed forever, in many ways sadly the same as before the yellow fever epidemic began.” 

While much has changed in Philadelphia after the epidemic, certain aspects stay the same. The dispute between Matthew Carey and the Free African Society serves as one such example. Race relations are still complex, and there are many challenges that will not be easily resolved.

“Many had had close calls with death and seen it on a daily basis in the streets of their neighborhoods; everyone—even those who had run from the city—considered himself or herself a survivor.” 

After surviving the epidemic, nearly everyone feels they have made it through a harrowing ordeal. They were surrounded by death and suffering for months. People who fled also see themselves as having endured a difficult situation. They did what they felt was necessary to survive.

“Sudden, mass death had stricken their city, and they were no wiser at all about the nature of the killer.” 

The cause of yellow fever continues to elude the medical profession at the end of the yellow fever epidemic in 1793, and it will remain a mystery for over a century. Frustration over the continued uncertainty surrounding the disease contributes to further rifts within the College of Physicians. It is difficult for them to agree when they have no evidence regarding the cause or the effectiveness of any particular treatment.

“Yellow fever terrorized many major cities throughout the 1800s—not only Philadelphia and Manhattan, but Boston, Baltimore, Mobile, Norfolk, and Portsmouth, Virginia, Savannah, Charleston, and Jacksonville, to name a few.” 

While the yellow fever epidemic in Philadelphia in 1793 is notable for many reasons, it is not the only time the fever strikes. It continues to prove a formidable foe into the next century. Few cities in the country are untouched by the disease.

“Although millions of fever cases were studied and thousands of autopsies performed, not much new was learned about the disease during the entire nineteenth century.” 

Medical breakthroughs regarding yellow fever do not arrive until the early 20th century. The medical profession in the 19th century still gravitates toward ancient practices, preventing any significant new information from being discovered. The climate starts to shift toward scientific methods near the end of the century, bringing new developments and understandings.

“If people in 1793’s Philadelphia had only listened when ‘A. B.’ had explained how to kill off mosquitoes breeding in water barrels, the fever there might have receded weeks sooner, and hundreds, if not thousands, of lives might have been saved.” 

A.B. is the name submitted on a letter to a newspaper editor. Once doctors understand in the 20th century that the mosquito is responsible for yellow fever, it becomes clear that the words of A.B. were entirely prophetic and, had they been listened to, may have staved off the epidemic. However, A.B.’s voice is mixed in with many others offering advice about the disease. It gets lost in the shuffle, and nearly lost to history.