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Much earlier than covid, and much more lethal
When yellow fever put the founders to flight
Covid-19 has understandably jolted contemporary Americans, accustomed as we are to generally good public health and relative freedom from grave infectious disease. But epidemics were regular visitors to the United States in earlier times, disrupting life and affording grim reminders of the mortality of us all.
The federal government had hardly got up and running under its new Constitution when a devastating malady gripped the national capital, Philadelphia. A rebellion in Saint-Domingue, the French colony in the West Indies that would become Haiti, triggered an exodus that sent thousands of refugees fleeing for their lives; some of these, knowing Philadelphia’s reputation as a haven for outcasts, landed in the city in the summer of 1793.
The ships that brought them carried yellow fever, which soon spread into the local population. Benjamin Rush was a Philadelphia physician, besides being a public figure: a signer of the Declaration of Independence, surgeon general of the Continental Army, professor at America’s first medical school. Rush observed the spread of the disease as he treated its victims.
The symptoms varied, sometimes diametrically, from patient to patient, Rush said. “The precursors, or premonitory signs, were costiveness”—constipation; “a dull pain in the right side; defect of appetite; flatulency; giddiness or pain in the head; a dull, watery, brilliant yellow or red eye; dim and imperfect vision; a hoarseness or slight sore throat; low spirits or unusual vivacity; a moisture on the hands; a disposition to sweat at nights or after moderate exercise, or a sudden suppression of night sweats.”
Yet some patients had no precursors at all. “Many went to bed in good health, and awoke in the night with a chilly fit. Many rose in the morning after regular and natural sleep, and were seized at their work or after a walk with a sudden and unexpected attack of the fever.”
Once the fever took hold, the symptoms were dramatic. “The vomiting, which came on about the fourth or fifth day, was accompanied with a burning pain in the region of the stomach. It produced great anxiety and tossing of the body from one part of the bed to another.” The vomiting could be violent. “The contents of the stomach were sometimes thrown up with a convulsive motion that propelled them in a stream to a great distance, and in some cases all over the clothes of the bystanders.”
The fever spread to the brain and nervous system. “In some it brought on syncope”—sudden loss of consciousness, “and in others convulsions in every part of the body,” Rush said. “Persons affected by syncope or convulsions sometimes fell down in the streets.” Thinking processes were severely deranged. “Delirium was a common symptom.” Patients didn’t know where they were or what was happening to them. “Some were seized with maniacal symptoms,” Rush wrote. “Such was the degree of this mania in one man that he stripped off his shirt, left his bed, and ran through the streets with no other covering than a napkin on his head at eight o’clock at night, to the great terror of all who met him.”
The illness understandably suppressed the appetite for food. Strangely, it seemed to heighten other appetites in those who survived the worst and began to recuperate. “The convalescence from this disorder was marked in some instances by a sudden revival of the venereal appetite,” Rush said, referring to the desire for sex. “Several weddings took place in the city between persons who had recovered from the fever.” Not everyone waited for the preacher. “Delicacy forbids a detail of the scenes of debauchery which were practiced near the hospital in some of the tents which had been appropriated for the reception of convalescents.”
The disease was called yellow fever for the yellow cast it gave to the skin and whites of the eyes in those most seriously afflicted. Rush noted that this was an ominous sign. “Its early appearance always denoted great danger.”
No one at that time knew the cause of the disease or its means of transmission. The people of Philadelphia were slow to react. “The first reports of the existence of this fever were treated with neglect or contempt,” Rush said. “A strange apathy pervaded all classes of people.” He gave warning of worse to come, and was criticized for terrifying the people too much. “I answered by lamenting that they were not terrified enough.”
The slow reaction was partly explained by that fact that the initial outbreak was among the poor of the city, who lived near the docks and always seemed to be ill with one thing or another. But then the fever began spreading. “This set the city in motion,” Rush recorded. “The streets and roads leading from the city were crowded with families flying in every direction for safety to the country. Business began to languish. Water Street between Market and Race Streets became a desert.”
Medical capacity was overwhelmed. “There was a deficiency of nurses for the sick, and many of those who were employed were unqualified for their business. There was likewise a great deficiency of physicians, from the desertion of some and the sickness and death of others. At one time there were only three physicians who were able to do business out of their houses, and at this time there were probably not less than 6,000 persons ill with the fever.”
The disease overwhelmed the emotions of the city, too. “I seldom went into a house the first time without meeting the parents or children of the sick in tears,” Rush said. “Many wept aloud in my entry, or parlour, who came to ask for advice for their relations.” In time the emotions grew too much to bear, and a collective numbness set in. “Grief after a while descended below weeping, and I was much struck in observing that many persons submitted to the loss of relations and friends without shedding a tear or manifesting any of the other common signs of grief.”
The disease drove away all who could manage to flee. Congress was not in session when the fever hit, but George Washington and members of his administration, including Thomas Jefferson and Alexander Hamilton, got away as soon as they credibly could. Hamilton contracted the illness yet survived. One man who didn’t survive was John Todd, whose widow Dolley Payne Todd, would go on to marry James Madison.
Thousands of others joined the exodus. “More than one half the houses were shut up,” Rush said. “In walking for many hundred yards, few persons were met except such as were in quest of a physician, a nurse, a bleeder, or the men who buried the dead. The hearse alone kept up the remembrance of the noise of carriages or carts in the streets.”
Amid the lack of knowledge about the origins and cause of the disease, explanations assumed political overtones. Two parties were emerging, the Republicans and the Federalists. The former followed Jefferson in admiring France; the latter Hamilton in preferring Britain. The Federalists (correctly, more by dumb luck than smart science) blamed the French refugees from Saint-Domingue for bringing the disease; the Republicans insisted the epidemic had local roots.
The epidemic lasted until autumn’s colder weather suppressed the population of mosquitoes that carried the virus from human to human. By then some five thousand people had died, of Philadelphia’s population of around 50,000. This death rate—of ten percent—made it the worst epidemic in American history (apart from those that ravaged Indian tribes). If the same death rate had applied during the covid epidemic of 2020-21, more than 30 million Americans would have died.
Epidemics would continue to plague American society. Yellow fever returned periodically, always in the summer and generally to seaports. Smallpox found new victims with each generation. Malaria, another mosquito-transmitted disease, became entrenched in large sections of the country. Cholera arrived from Europe in the 1830s and killed thousands. Influenza carried off half a million in the 1910s. AIDS emerged in the 1980s and claimed hundreds of thousands. Covid has killed 600,000.
After each epidemic the country recovered, often quickly. Public life resumed, though private sorrow persisted. Philadelphia showed how it was done. “It afforded a subject of equal surprise and joy to behold the suddenness with which the city recovered its former habits of business,” Benjamin Rush remarked. “In the course of six weeks after the disease had ceased, nothing but fresh graves and the black dresses of many of the citizens afforded a public trace of the distress which had so lately prevailed in the city.”
The recovery from covid has been slower than that from yellow fever in 1793, not least because this latest epidemic has been global rather than local. New variants arrive from abroad, complicating the development of broad immunity. But humans, and certainly Americans, have a habit of turning toward life. They bury the dead and get back to doing what they were doing before the epidemic struck.