The yellow fever epidemic that swept through Philadelphia in 1793 was a medical crisis that exposed the profound limitations of eighteenth-century knowledge. As the nation’s capital and largest city, Philadelphia was devastated by a disease that killed approximately 5,000 residents, about ten percent of its population, between August and November of that year. Physicians at the time lacked the concept of germ theory, which would have identified the virus and its transmission by the Aedes aegypti mosquito. Instead, the medical community relied on ancient and classical ideas of disease, which led to a variety of often aggressive and contradictory treatments. The primary focus of medical intervention was not on curing the disease itself, but rather on rebalancing the patient’s internal system.
The Dominant Medical Philosophy
The treatments administered during the epidemic were largely rooted in the centuries-old humoral theory, which posited that health resulted from a balance of the four bodily fluids: blood, phlegm, yellow bile, and black bile. Disease was understood as a systemic imbalance or disruption in the body’s natural state, often caused by external factors like spoiled air. Within this framework, the most influential American physician, Benjamin Rush, developed a specific theory of yellow fever.
Rush believed the fever was a condition of excessive excitement and tension in the circulatory system, requiring a vigorous counter-response. This view aligned with a therapeutic approach known as “Heroic Medicine,” which favored dramatic interventions to forcibly restore the body’s balance. The treatment’s rationale was depletion—the aggressive removal of fluids and substances to reduce the perceived internal excitement.
Heroic Treatment: Bleeding and Purging
The practical application of the dominant medical philosophy involved two intensely aggressive procedures: bloodletting and purging. Bloodletting was performed by opening a vein and drawing blood, sometimes in extremely large quantities. Rush advocated for copious bleeding, sometimes drawing 70 to 80 ounces of blood over five days from a single patient. The intent was to reduce the volume of the “hot” humor (blood), thereby lowering the systemic tension associated with the fever.
The second major component was a powerful purge designed to empty the digestive system of toxic bile. This purging mixture was famously known as the “ten and ten,” consisting of ten grains of calomel (mercurous chloride) and ten grains of jalap, a strong vegetable laxative. Calomel, a highly toxic mercury compound, induced violent vomiting and diarrhea. The goal of this harsh regimen was to evacuate the body and clear the perceived source of the disease, a process that was repeated multiple times for many patients.
Competing Medical Approaches
While Rush’s aggressive methods were widely adopted by many American practitioners, significant alternative treatments existed that rejected the philosophy of heroic depletion. This opposing school of thought, often associated with French physicians who had experience with yellow fever in the Caribbean, favored a milder, palliative approach. Instead of depletion, these doctors focused on supportive care to help the patient’s body recover naturally.
One prominent advocate was the French physician Jean Devèze, who managed the fever hospital at Bush Hill. His “French cure” involved rest, a mild diet, and the use of stimulants and tonics. Another proponent, Dr. Edward Stevens, successfully treated Alexander Hamilton and his wife with a cold bath and a regimen of bark and wine. This gentler approach utilized Peruvian bark (containing quinine) and Madeira wine for stimulation and hydration. These methods focused on strengthening the patient and managing symptoms.
Supportive and Environmental Measures
Beyond the internal medical interventions, doctors and city officials gave advice focused on managing the patient’s environment and preventing the spread of the disease. The prevailing miasma theory, which held that disease was caused by foul odors or “bad air” from decaying matter, drove early public health efforts. Consequently, there were widespread demands to clean the city streets and remove refuse, as physicians incorrectly believed that rotting refuse was the source of the pestilence.
For patient management, cooling applications were frequently recommended to combat the fever, including cold baths or sponging the patient with cold water. Isolation and quarantine were also advised, leading thousands of citizens to flee Philadelphia for the countryside. Simple recommendations for fresh air and light broths were given to maintain the patient’s comfort and strength.