Philadelphia Story: The Diseased City, Yellow Fever Outbreak of 1793

The Arch Street wharf, where the first cluster of Yellow Fever cases were identified.

The Diseased City: The Broadside Mortality, 1793

Why should cities be erected, if they are only to be the tombs of men?-- Noah Webster in 1796

There was something however, in the state of the atmosphere in the city, or in the constitution of the inhabitants, peculiarly favorable to the operation of the contagion. .. --Dr. William Currie

In his History of the United States, Henry Adams speculated about the year 1800: "if Bostonian for a moment forgot their town meetings, or if Virginians overcame their dislike for cities and pavements, they visited and admired, not New York, but Philadelphia" (White, 8). Certainly, federal era Philadelphia was acclaimed, though only to an extent. The city was relatively clean, safe, and prosperous by the standards of the day, but starting in 1793 a series of yellow fever outbreaks reminded both the friend and foe of the city of the physical danger of urban life. Many linked these feverous contagions to the diseased moral condition of city-dwellers. Even Jefferson, who appreciated Philadelphia's refinement, preferred the moral solidity of small town/rural life. And this doubt over the morality of city life spread to many Philadelphians, especially as the plague brought out the most selfish aspects of the populace. However, the city's famed philanthropic nature also worked to counteract the fear. The construction of the water works was an attempt not just correct a physical deficiency, but a moral one as well.

Dock Street Market below Walnut, Philadelphia, PA

On the most basic level, the genesis of the Water Works must be understood by remembering what the lack of a reliable water source could mean to a city. Beyond the obvious need for drinking water (though the eighteenth century city-dweller drank relatively little water), it was needed to fight fires, a terrifying prospect in a city of densely packed wooden structures, for basic hygiene, and as many thought, for the prevention of disease. Like all American cities of the 1790's, Philadelphia relied on an inadequate hodgepodge of wells, cisterns, and springs for most of its water. For large cities, these scattered sources proved inadequate, especially as they were quickly depleted in hot, dry summers, and were repeatedly strained by a burgeoning population.

Coupled with an inadequate water supply, the prevalence of disease, especially in busy port cities, proved radically de-stabilizing. Though outbreaks of small pox, influenza, and yellow fever had occurred in every American city, Philadelphia's yellow fever plague of 1793 displaced previous notions of the disease, and shook the nation's largest city to its foundation. The birth of the Water Works must be seen largely in the context of this devastation--of a city in which "water, earth, and air" had been befouled. That the "Athens of America" could be so susceptible to disease, so squalid and so dirty, was an affront to its Franklinian persona, and to Penn's planned efficiency exemplified by his gridded street plan. The fever and the attendant chaos challenged the enlightened mind's ability to control Nature, and challenged Philadelphia's noted reputation for charity. Thus this story concerns the response of Philadelphia's elite group of inventors, scientists, doctors, writers, publishers, and philanthropists to this catastrophe.

1793: Disaster in the Capitol

In the summer of 1793 Philadelphia was unusually hot, and dry, and congested. By June, a thousand refugees fleeing from revolution on the island of Santo Domingo had poured into the city. Their tales of slave revolt and of a fever epidemic engendered some support, and $15,000 dollars in relief money was quickly raised. However, many Philadelphians were also slightly wary of these newcomers, as though this very heterogeneous group (white, black, rich, poor) brought with them some of the 'tainted' views supporting slavery; or perhaps they were on the 'wrong' side of the French revolution. However, the islanders were not the only ones suspected of spreading 'moral contagions'. Dr. Stephen Currie faulted the moral constitution of all Philadelphia's inhabitants; and as the quote at the top of this page indicates, saw the prevalence of fever as a direct result of this lack. In fact, the Caribbean immigrants did carry the fever with them, though in a form that would not be recognized by doctors for over a century (see below). And this highly contagious disease found a welcome host in the fetid, dirty, and cramped environment of Philadelphia.

Dr. Benjamin Rush

In August of 1793, several prominent Philadelphia physicians gathered to discuss a worrying trend: an increasing number of patients with symptoms of nausea, black vomit, lethargy, and yellow skin coloration. Among those present was Dr. Benjamin Rush, the city's most prominent doctor, signer of the Declaration of Independence, and supporter of the state and national constitutions. He quickly concluded that the culprit was the dreaded yellow fever. His pronouncement quickly spread through the city, itself a forerunner of the disease that would eventually kill close to ten percent of the population. By the end of August, Rush advised all "that can move, to quit the city." As the fever spread, and as doctors were unable to agree either on its cause or its proper treatment, panic soon held sway.

We should remember that the Philadelphia of 1793 was the nation's largest city and its national capitol, as well as the Pennsylvania state capital. The fever thus, was not just a 'local' problem, but one of national significance, and particularly foreboding to a young republic. Jefferson, Washington and Hamilton were only the most famous residents of the area; and as the disease attacked the prominent and common alike, all remained susceptible to the fever. So, the national government disbanded with the hope of returning in cooler weather. And though many of those with means followed Rush's advice, they were not always in time. Both Alexander Hamilton and his wife contracted the fever and were treated as outcasts on their flight to Albany--a pattern that would repeat itself for almost all of the diseased refugees.

Stephen Girard

Rumors of husbands abandoning wives, and parents their children ran rampant. However, many Philadelphians stayed in order to minister to the sick, and to prevent the total collapse of the city. Among those who remained, Stephen Girard, most physicians, the African-American clergymen, Richard Allen and Absalom Jones, and the largely African American corps of attendants and nurses stand among the foremost in bravery. Their unselfish participation stood in contrast to those who fled the city. It was also unlikely from one such as the French born Girard--who was on his way to becoming the richest man in the country.

Girard, with the help of Peter Helm (a Cooper by trade) oversaw the temporary asylum for the sick at Bush Hill, a commandeered mansion on the outskirts of the city. He also used his considerable negotiating skills to install Dr. Jean Devéze, one of the Santo Domingan refugees, as its primary physician. Devéze kept his patients clean, comfortable, and prescribed limited dosages of quinine and stimulants--the same 'French treatment' that cured Hamilton and his wife. His methods were generally more effective than the 'heroic' bleeding and purging prescribed by Dr. Rush and his circle, and helped saved many desperately ill people. Though as a Domingan refugee and French trained doctor, neither he nor his methods won the favor of Philadelphia's elite core of physicians. And most Americans who wrote of the fever failed to include Devéze in their accounts. Dr. Rush never mentioned his name in print and the journalist/publisher Mathew Carey's famous (and first) "Short Account" of the fever only refers to Devéze in a footnote (97).

Battle of the Doctors: Causes and Remedies

He combated an opinion I had casually formed respecting the origin of the epidemic, and imputed it not to infected substances imported from East or West, but to a morbid constitution of the atmosphere, owing wholly or in part to filthy streets, airless habitations, and squalid persons.---Charles Brockden Brown, Arthur Mervyn (161)

Philadelphia's famed corps of physicians could agree neither on the causes of the yellow fever, nor its most effective remedy. Brown's passage from Arthur Mervyn points to the two prevailing theories as to its origins: the disease stemmed from noxious fumes emanating from blocked sewers and/or rotten cargo on the waterfront, or that it was a foreign 'contagion' (the concept of 'germ was unknown) brought by refugees to the city, most likely from the Caribbean. The debate was not new, and though it gained a great deal of urgency in the summer of 1793, it would not be resolved until Walter Reed discovered that yellow fever is transmitted by the female mosquito Stegomyia fasciata.

Open sewer in Philadelphia 

However, both conjectures hovered maddeningly close to the truth. The mosquito was unintentionally imported from the Caribbean, mainly by the large number of Santo Domingan refugees. As well, the standing pools of water from blocked sewers, and the humid, marshy conditions of the local environs provided ideal breeding grounds for the insects. Dr. Rush insisted that the sources of disease stemmed from water problems. In an 1805 essay he writes:

The want of sufficient force in the water which falls into theo common sewers. . .renders each of their apertures a source of sickly exhalations. . .(Wood, 227)
In Many parts of the vicinity of the city are to be seen pools of stagnating water, from which there are exhaled large quantities of unhealthy vapours, during the summer and autumnal months. (227)

Various doctors almost made the correspondence between the prevalence of mosquitoes, the stagnant water, and the yellow fever. In 1796, Dr. Valentine Seaman wrote that:

It has been observed by Dr. Rush, in Vol. 1 of his Med. Observations, as well as by Dr. Lind, that musquetoes generally attend a sickly season--the same was observed here during last summer: the cause is very clear, for the circumstances favoring the rise of putrid miasmata, equally favor the generation of these insects" (Blake, 7).
Though doctors did not discover the root causes of the disease, they did realize some of the ways to prevent its spread: quarantining incoming ships and providing a more effective system of for watering and cleaning the city.

Clean Water: Answer to the Plagues ?

Many observers, other than the doctors, also concluded that a possible source of disease lay in Philadelphia's unsanitary conditions. Benjamin Henry Latrobe, the country's most famous architect and engineer, concluded in 1798:

Benjamin Henry Latrobe

Thus, therefore, we have a proof that there does exist in the mode by which the city is supplied by water a very abundant source of disease, independent of the noxious exhalations of the narrow and filthy alleys and lanes. It is true that the inhabitants of Philadelphia drink very little water. It is too bad to be drunk, and that which is used in tea and cookery loses, no doubt, most if not all, of its noxious quality . . .(Latrobe, 97)
As to the public sewers there are not very many of them, and I do believe they are productive of much mischief. . .(97)

The great scheme of bringing the water of the Schuylkill to Philadelphia to supply the city is now become an object of immense importance, though it is at present neglected from a failure of funds. The evil, however, which it is intended collaterally to correct is so serious and such magnitude as to call loudly upon all who are inhabitants of Philadelphia for their utmost exertions to complete it. (98)

During the 'plague decade' of the 1790s, attempts were made to clean the city by regularly washing its streets with fresh water. As Noah Webster advised, "the use of water cannot be too liberal." (Blake, 9) Unfortunately, the availability and expense of water contradicted his, and many others', mandate for cleaner cities. The quest for clean and cheap water, both predated the plague of '93 and led reformers to the waters of the Schuylkill.

Benjamin Franklin had worried over the issue of clean water enough to leave both his native city of Boston and his home of Philadelphia large sums of money in his will of 1789. The 1000 pound bequest to each city was to be invested and the moneys spent on new water systems. Characteristically, he had a specific plan:

And having considered that the covering of the ground plot of the city with buildings and pavements, which carry off most of the rain, and prevents its soaking into the Earth and renewing and purifying the springs, whence the water of wells must gradually grow worse, and in time be unfit for use, as I find has happened in all old cities, I recommend that at the end of the first hundred years [of investing his money] if not done before, the corporation of the city Employ a part of the hundred thousand pounds in bringing by pipes, the water of the Wissahickon creek into town, so as to supply the inhabitants, which I apprehend may be done without great difficulty, the level of that creek being much above the city and may be made higher by a dam. I also recommend making the Schuylkill completely navigable. (Blake, 4)

Both Franklin's and Latrobe's 'can do' optimism and civic spirit, as well as Brockden Brown's and Noah Webster's' depiction of the City as dirty and noxious, inform the building of the Water Works, as well as it's reception and power as a cultural icon for the city and for the country. (source: Virginia X-Roads)