Benjamin Rush and the Yellow Fever Outbreak of 1793

Dr. Benjamin Rush painted by Charles Willson Peale, 1783

Today marks three full weeks that my family has been in insolation at home due to Covid-19. The shock of having this pandemic completely upend our lives, careers, education, and travel plans is still very vivid, but we're getting through it as best we can, day by day.

This morning, the Washington Post featured an article about a previous epidemic, the 1793 Yellow Fever outbreak in Philadelphia, highlighting the work of Dr. Benjamin Rush, a notable colonial-era physician and signer of the Declaration of Independence. Dr. Rush is connected to my family through our Stockton line, and I've written about him before, when sharing details about the life of his father-in-law, Richard Stockton, another signer of the Declaration of Independence. The link from my Stockton ancestors to Richard Stockton is distant, as we descend from different lines of the Stockton tree. His great-grandparents, Richard and Abigail Stockton, are my tenth great-grandparents and the Stockton line's immigrant ancestors, having emigrated from Cheshire County, England to New Jersey in the mid-1600s. Richard Stockton is my 2nd cousin, 9x removed.

Richard Stockton, a future member of the Second Continental Congress, married Annis Boudinot, a highly regarded poet, in 1858. They raised their children at Morven, which is now a museum in Princeton, New Jersey.

 Annis Boudinot and Richard Stockton

Their daughter Julia (1759-1848) married Benjamin Rush in Philadelphia on January 11, 1776. She was a well-educated heiress who would come to be an important female voice in post-colonial America. He was a member of the Sons of Liberty and a prominent physician. Benjamin and Julia settled in Philadelphia, his hometown, and had thirteen children together.

Julia Stockton in the year of her marriage; Benjamin Rush and Julia Stockton Rush

A wonderful article in Smithsonian Magazine details the marriage of Benjamin and Julia, from its romantic beginnings, through the many trials they would encounter in the late 1700s. They lost four of their children in infancy. Benjamin served in the Revolutionary War and "accepted an appointment as surgeon-general of the middle department of the Continental Army" [Wikipedia], which he later had to resign due to questions about accurate reporting of supplies and death rates. Benjamin also fell out with George Washington after writing letters critical of his leadership. Meanwhile, Julia's father, Richard Stockton, was captured by British troops and subjected to horrific mistreatment in prison, from which he never recovered. Morven was ransacked by the British, its library burned. This was a family that, despite their privilege, endured a lot of struggles. One of the greatest was the Yellow Fever outbreak that consumed Philadelphia in 1793. As the virus spread through the city at an alarming rate, Julia fled with her children, as did many who could. Benjamin stayed there, determined to assist a population besieged by illness and death. Quoted from the Smithsonian article:

Late that summer [1793], she and Benjamin faced their greatest challenge—the yellow fever epidemic in Philadelphia, during which she and their children repaired to Morven while he turned their Philadelphia house into a makeshift ward. On September 22, she wrote to her husband knowing it might be their last communication. “My dear Dr. Rush,” she wrote, in a recently discovered letter, one of eight new documents from this fraught period, “I have endeavored to keep up my spirits thru the whole of this great calamity with which we are visited and my friends all say I have done it wonderfully—but your two last letters have been almost too much for me.” 

Those “two last letters” reported the deaths of many of their friends and neighbors. In their own home, one apprentice had already died and several others were infected, including Benjamin’s sister. “If you get sick again yourself,” Julia continued, “which I very much fear, what shall I do when I come to you, with the house full of sick men.” Still, she did not insist he flee, as many other physicians had.

Dr. Rush's sister, Rebecca, died of the fever. Somewhere between 4,000 and 5,000 Philadelphians would ultimately succumb to Yellow Fever in 1793. It was a viral, as opposed to bacterial, epidemic and the medical community had little knowledge of how to best prevent the spread of it. 

From the American Journal of Psychiatry:

Philadelphia was the medical capital of the new republic, its physicians the best to be had, but the medical science of the time provided no sure grounds to distinguish between competing theories of cause. It would be more than another century before the mosquito was identified as the vector of yellow fever and a filterable virus as its agent. 

More than one-third of Philadelphia’s population of 50,000 fled the city to take refuge in the surrounding countryside; before the plague was over, more than 4,000 lives had been lost. Panic beset the community, and doctors were among those who took flight to escape the pestilence. Ten of those who remained died of the disease. After illness and defection, only three physicians were available to treat no fewer than 6,000 cases. Rush, after dispatching his wife and children to a safe area, remained to fulfill his medical responsibilities.

In the article Philadelphia Under Siege: The Yellow Fever of 1793 by Samuel A. Gum, the author describes how Yellow Fever spread wildly in the summer of 1793, sparking outright panic, upending the lives of citizens and the government, and turning hospitals into a horror. He also sheds light on Benjamin Rush's important role amidst the chaos:

Yet during such a tragedy, there was also an intense struggle for a cure and containment. Doctor Benjamin Rush, one of the signers of the Declaration of Independence, became the leader of the fight against Yellow Fever. Though urged to flee the city like others, Rush said, “I have resolved to stick to my principles, my practice, and my patients to the last extremity.” Dr. Rush gave the people of Philadelphia courage and hope. 

Fear engulfed the city of Philadelphia. While many resorted to prayer and appealed to the divine, Dr. Rush believed that Yellow Fever was caused by unsanitary conditions, especially those of the docks, sewage system, and rotting vegetables such as rotting coffee from the Arch Street wharf. He concluded that the illness was not transmitted from human to human but by “putrid exhalations” in the atmosphere. He also recognized that weather played a part in the epidemic and that the infection did not spread from human to human contact. Though many people of the time wanted to point blame at the newly arrived Saint Domingue revolution refugees, Rush was adamant to not point the blame to outsiders but instead accuse the sanitary conditions of the city and implore residents to clean up the city so as to not “entrail the disease upon future generations.” 

He believed the epidemic could be prevented by cleaning the docks, pumping out the bilge water of ship (water that collects and stagnates in the bilge of a ship), cleaning sewers more often, washing the streets in warm weather, removing filth from home better, emptying toilets more often, stopping building so close in alleys, and eating less meat in the summer. In regards to disease, Rush has said, “To every natural evil, Heaven has provided an antidote.”

Dr. Rush's methods were controversial. He was a devotee of bleeding, which was popular at the time, but is now known to be ineffective, and may have even hastened death in some circumstances. But his dedication to the people of Philadelphia during their time of greatest crisis made him a hero in post-colonial America. After the Yellow Fever epidemic subsided, Benjamin Rush continued his medical career at Pennsylvania Hospital. While there, he became a passionate advocate for the rights of the mentally ill. He was a pioneer in the field of mental illness, and an early proponent of the idea that the mentally ill should be treated with respect. He died of typhus in 1813, at the age of 67, and was buried at the Christ Church Burial Ground in Philadelphia.

Coincidentally, I just received a Yellow Fever vaccine in January, ahead of an anticipated work trip to Uganda, which has now been cancelled due to the Covid-19 pandemic. You can only get the Yellow Fever vaccine at a couple of locations in the Bay Area, and it was inconvenient and expensive to have it administered. At the time, I was somewhat exasperated by the process. Given how rapidly the world has changed in the past two months, and how much we non-medical professionals have quickly had to learn about infectious disease, I now have a different outlook on that experience. How fortunate we are to be able to protect ourselves from Yellow Fever in the modern day.

The people of Philadelphia had no protection from a horrific virus in 1793, much as we have little defense against Covid-19 right now. We know life will not be the same again until there is a vaccine. As we remain in our homes, a situation uncomfortable and inconvenient for all of us, let us give thanks to the Benjamin Rushes of the modern era; all those dedicated nurses and doctors on the front lines of this fight, who put themselves at risk to save those who can be saved. Thank you to the scientists who are working tirelessly on a vaccine under great pressure. We are all living through a remarkable and terrible time in history.