spread in clusters near the waterfront, where recent arrivals included ships containing slaves and immigrants fleeing slave revolts on the island of SaintDomingue. (The island now divided between Haiti and the Dominican Republic).1 Philadelphia’s physicians had little to no knowledge of the disease. There had been a few sporadic outbreaks between 1741 and 1762 (Finger), more than 30 years prior, so very few had encountered it before. Initially, they wrote off the symptoms as the usual fall fevers, but as cases multiplied, they grew increasingly perplexed. Why was the fever spreading so quickly? More importantly, what was the mode of infection? The epidemic quickly turned into a devastating crisis. Few citizens of Philadelphia were unaffected as the disease periodically ravaged the city between 1793 to 1799. Each new wave brought terror to citizens. In 1793 alone, over 5000 Philadelphians died – approximately one tenth of the city’s population. The disease pushed more than half of the population out of the city for fear of being infected (Kornfield 189). But such an overview does not tell the whole story. Even the early cases laid bare the divergent interests of various stakeholders, resulting in conflicted rather than a united response. The esteemed Dr. Rush was the first to recognize the symptoms based on his experiences as a student during the 1762 epidemic in Philadelphia – he was 17 years old at the time. He identified it as “bilious remitting yellow fever” (Maienschein) – “bilious” because one of the symptoms was an excess of infected bile; “remitting,” because there was a lull in symptoms between moderate and severe phases of the disease; and “yellow” because of the characteristic hue of jaundiced patients. Rush’s diagnosis and talk of a possible outbreak made many people uneasy, and some started to leave the city. But Rush’s voice was not the only one. Many physicians disagreed with Rush’s diagnosis of Yellow Fever altogether or disputed that an epidemic would result on the basis of a few cases. Newspapers were largely muted in their response, providing only basic cleaning recommendations. The Mayor of Philadelphia, Matthew Clarkson, minimized the threat because he worried that widespread fear would stifle the economy. The city’s guidance for citizens consisted of folk remedies such as chewing garlic or wearing tarred ropes (Maienschein). Clarkson’s approach is understandable in one sense. Declaring an epidemic too early would cause unnecessary alarm. But not taking the threat seriously and failing to alert the public was also dangerous. Uninformed about the severity of the situation and without clear guidance, the public remained mostly in the dark as fatal cases skyrocketed. 1 The yellow fever outbreak was most likely due to the ships arriving with these refugees. The fever was a regular occurrence in Haiti due to the mosquitoes, and it was likely that these ships arriving at Philadelphia also imported Aedes aegypti mosquitoes. 55
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