“Bring Out Your Dead”: The Yellow Fever Epidemic of 1793

One of the worst epidemics in American history occurred in the then capital of the United States, Philadelphia, in the late summer and fall of 1793. The yellow fever epidemic of 1793 killed almost 10% of the city’s population and forced the young government of the United States and President George Washington to seek shelter away from Philadelphia.

“Girard’s Heroism” depicts Philadelphian Stephen Girard personally taking victims of the 1793 yellow fever epidemic into his carriage to be taken to a hospital.

The 18th century was full of epidemics including smallpox, typhus, influenza, measles, and yellow fever.  Yellow fever (also referred to as ‘the bilious fever’) was a brutal disease to contract and suffer.  Once a person got yellow fever they would come down with aches and a fever. The disease would then attack the liver causing jaundice which turned the person’s skin a yellow color (hence the name yellow fever). Shortly after that, they would begin to bleed from the mouth, nose, and eyes and vomit black blood. It would usually only take a few days for the person to die from the disease. Almost 50% of all those who contracted the disease died.

Yellow fever arrived in Philadelphia in the spring of 1793 when a ship carrying French refugees from the Haitian Revolution arrived from the Caribbean. In an era before germ theory, there were numerous erroneous thoughts as to the cause of this epidemic and how it spread. Many people assumed the fever was caused by putrid air from rotting produce on the docks since this is where the first cases appeared.  Others blamed the refugees for bringing the disease into the city.

Arch Street Docks in Philadelphia

Among the early victims of the disease was a member of the President’s house.  Polly Lear, the 23-year-old wife of George Washington’s secretary, Tobias Lear, died from yellow fever on July 28, 1793.  Washington was personally devastated and attended her funeral the following day at Christ Church in Philadelphia, the only funeral he would attend during his presidency.  Polly was given a funeral similar to a state funeral, with her pallbearers being Alexander Hamilton, Thomas Jefferson, and Henry Knox.  Even though the fever would claim the lives of people close to George Washington, he, himself, never described fear or anxiety of catching the disease.

The President’s House in Philadelphia.

By August of 1793, cases of yellow fever in Philadelphia reached a point where local doctors declared an epidemic. About 20 people were dying every day of the disease.  The College of Physicians in the city gave recommendations to slow the spread of the fever. They believed it was contagious from infected people and travelled through the air. People wore vinegar-soaked cloths around their mouths and noses, stayed in their homes, stopped shaking hands, kept distance on the streets from others, and lit bonfires in the city streets hoping the smoke would kill the disease in the air. People ceased to visit those afflicted with the fever, and the houses of those who had the fever were marked for all to avoid. They also sought to quickly bury people who died from the fever to try and stop the spread.  People fled the city in droves.  Nearly 20,000 people ultimately escaped the city.  Washington described the city as “almost depopulated by removals and deaths.”

With little modern medical knowledge, doctors worked to care for those suffering.  One of the prominent local doctors treating the sick was Dr. Benjamin Rush, who 17 years earlier had signed the Declaration of Independence.  Dr. Rush treated the disease through bleeding his patients, which likely only worsened people’s condition.  Based on a false premise that the human body was regulated by four “humors,” some, like Dr. Rush, believed by purging numerous pints of blood from a patient, the body’s balance could be restored.  This almost never worked, and often had the opposite effect of making the patient’s suffering more extreme.  Regardless of the ineffectiveness of this treatment, Dr. Rush and dozens of other doctors, clergy, and nurses displayed tremendous courage as they stayed in the city visiting the stricken and tending to them.  Many of themselves would contract the fever and die as a result.

On September 5, Secretary of the Treasury, Alexander Hamilton came down with the fever, as did his wife, Eliza.  The Washingtons, concerned for Hamilton’s health, sent him six bottles of wine.  His political rival, Thomas Jefferson, sneered that Hamilton was faking and that he only had “an autumnal fever.”  Hamilton was treated by a boyhood friend from the Caribbean, Dr. Edward Stevens. Instead of using Dr. Rush’s bloodletting, he administered doses of quinine, Madeira, cold baths, and laudanum.  Hamilton remarkably recovered after a few days.  Hamilton proselytized this alternative treatment.  This led to debates between doctors over the best method over treatment and led to some doctors blaming colleagues for the massive amount of deaths occurring.  Congressman Fisher Ames noted that “everything that ought to be called fact is disputed, and all that should be modestly confessed to be ignorance is affirmed.”

A hospital was established just outside the city at an estate called Bush Hill for yellow fever cases.  Dozens of African Americans were called up to help treat the sick, with the mistaken assumption that African Americans were immune to the disease.  Many of them would likewise die heroically attempting to care for the sick.  Absalom Jones and Richard Allen became prominent African American heroes in the fight against yellow fever.

Bush Hill, Philadelphia.

Fear pervaded the entire country as other cities in the United States became terrified the disease would come to their homes. Boston, New York, and Baltimore put up roadblocks.  People who showed signs or symptoms of the disease on stagecoaches were promptly kicked off the coach and left to die on the side of the road.  In New York, they discussed calling out the militia to prevent sick people from entering the city.  While they feared the disease spreading into their own cities, they did show generosity by sending money to Philadelphia for the care of the sick.

Amid the chaos in the capital, on September 10, both George and Martha Washington left Philadelphia to return to their home at Mount Vernon, Virginia.  While Washington did not fear for his own safety, he did fear for Martha’s and had asked her to leave, but she refused to leave his side.

By October the fever hit its peak.  Nearly 100 people a day were dying of the fever.  Carts creaked through the city with men shouting out “Bring out your dead!”  Dead bodies were stacked and taken to dead houses and burial sites.  One major burial site was the Southeastern Square in Philadelphia, today known as Washington Square.  This area was a potter’s field previously and during the Revolutionary was the burial site of hundreds of American British troops who died from disease in the city.  Today it is the site of the Tomb of the Unknown Revolutionary War Soldier.  More than 1,300 people who died of yellow fever were buried in this square, so many that the burying ground was filled to capacity and closed.

Washington Square Park.

At the end of October, Washington wanted the work of the government to return, but decided that they shouldn’t meet in the fever ridden city.  Instead Washington set up temporarily at Germantown, Pennsylvania, just outside of the city.  For most of the month of November Washington and his cabinet would work in Germantown.  The site of a battle where Washington fought in 1777 now served as the temporary White House for a month.

The Germantown White House, now a National Park Service site.

By mid-October, the temperatures began to drop to around freezing temperatures and the cases of yellow fever began to disappear.  By mid-November, as it continued to get colder, they disappeared entirely and life slowly went back to normal in Philadelphia.  By December, Washington and his cabinet returned to Philadelphia.  The fever receded and life began to return to normal.  What no one realized at the time was that the disease was actually spread by mosquitos, a fact not discovered until Dr. Walter Reed figured it out in the twentieth century.  The cold weather killed the mosquitos, which ultimately ended the plague in 1793.

The toll of the epidemic on the people was apparent.  Nearly 5,000 people had perished during those few short months, equal to about 10% of the entire city.  The actual mortality rate was closer to 20% if you take into account that 20,000 people fled the city and thus the population was only about 30,000 that fall.  In December, Martha Washington wrote “Black seems to be the general dress in the city. Almost every family has lost some of their friends.”

Among those who had perished, were the Washingtons’ good friend Mr. Samuel Powel, who, along with his wife Elizabeth, were actually invited to Mount Vernon to escape the disease. Washington heard the news that “Mr. Powel lost his life in consequence of a humane visit to his house in town, to provide for the accommodation of a favorite servant.” Dr. Benjamin Rush’s own sister died on October 1, 1793 in his home.  Another prominent person to bear a large burden of grief was Dolley Payne Todd.  In the matter of just a few weeks, her husband John Todd, both his parents, and her three-month-old child died of yellow fever.  Dolley was spared and went on to marry James Madison, later becoming one of America’s most famous first ladies.

As in warfare, the extraordinary circumstances of the epidemic drew out the best and worst of people.  Despite the huge toll in lives lost, the survivors and the nascent federal government persevered.

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