Patients and Patience: The Long Career of Yellow Fever

Simon Finger

The “Germantown White House,” where George Washington, where Washington escaped the epidemic of 1793. Photo taken by Jack Boucher of Historic American Buildings Survey, 1973. Courtesy Wikemedia Commons.

In 1793, Philadelphia printer Mathew Carey published his Short Account of the Malignant Fever, recounting the tumultuous season that had just passed. Yellow fever had struck Philadelphia for the first time in three decades, killing 5,000 people. Americans flocked to his terrifying narrative, which ran through three more editions within six months; even two centuries later, his story of the plague still holds power. As of this writing, the Washington Post has already published four pieces comparing the 1793 yellow fever with 2020’s COVID-19, on matters of partisanship, paniccommunications, and quarantine.[1]

It’s not hard to see why scholars and journalists alike are drawn to Carey’s version: A mysterious fever began spreading through the city. The most celebrated doctors clashed over how the disease spread and how to treat it. Government faltered in its response before absconding altogether. Panic engulfed the populace, and residents fled in droves to the assumed safety of the countryside. Carey vividly details the desolated city: the empty streets, the closed harbor, the constant peal of funeral bells, families shattered by death or abandonment. But in the depths of the crisis, Carey highlights the valiant work of the volunteers who came together, transcending boundaries of religion and class, in the shared effort to shepherd the city through the storm of 1793. Carey’s picture of republican virtue triumphant was often incomplete, notably criticizing the city’s free black community, but he eventually came to acknowledge their service as nurses, carters, and other volunteers, who joined in that same spirit that allowed the city to rise phoenix-like from the ashes.[2]

The lesson of a city saved by shared sacrifice and civic responsibility is an inspiring one for 2020, when so much hangs upon popular cooperation with calls for social distancing, home sheltering, and public masking. But while Carey’s story ends happily in 1793, that outbreak was only the beginning of a longer ordeal, and one that carried different lessons for the present. Yellow fever returned to North America every summer until 1805, claiming more than 12,000 lives in the process.

At first, Philadelphia’s new Board of Health optimistically hoped for public cooperation: “Individual interest should yield to a temporary sacrifice, in order to avert the public calamity. It is a duty every citizen owes to the community . . . impeding the progress of contagion.” Without citizens helping to keep the city clean, to inspect conditions, and to inform on health code violators, the regulators conceded, their success could only be “partial and limited indeed.”[3]

But unity soon devolved into bitterness and acrimony. Doctors clashed in vain over the cause and cure of the disease, nowhere more furiously than in Philadelphia. The full scope of the fever controversy was complex, but revolved around a central question: Was yellow fever a specific and contagious disease imported from the West Indies, or a generic inflammation produced by local environmental conditions and atmospheric contamination? Even during the first outbreak, poet Philip Freneau satirized the division between climatists and contagionists, juxtaposing “Doctors raving and disputing” with “Death’s pale army still recruiting.” Unfortunately, the doctors’ quarrel was only warming up.[4]

“#MaskUpPHL” Campaign from the Philadelphia Board of Health, 2020. Courtesy

Every year, as the fever returned to claim more victims, the rival schools (quite literally: Climatist Benjamin Rush founded his Academy of Medicine because the largely contagionist College of Physicians rejected his ideas) renewed their fight in the public eye, trading charges of ignorance, superstition, and malpractice. As Freneau had suggested, the argument produced more heat than light, and this vitriol began to wear away at popular faith in medical expertise. Every year after 1794, the Board attempted to enforce stricter and stricter quarantines, but the public pushed back ever more resentfully at these obligations, its ire compounded by the fact that the regulations seemed to powerless to control the epidemics.

These tensions came to a head in the catastrophic outbreak of 1798. Because more people fled the city sooner, the summer ended with a lower death toll than the 1793 outbreak, but it had a higher mortality rate among the poor residents who could not afford to leave, taking some 3,500 lives. The Board found itself deadlocked at every turn by internal discord. And the public was losing patience with the failure of both climatists and contagionists to deliver a single tangible success in the fight against yellow fever. Quarantine evasion and other measures of resistance reached their peak.

Finally, the Board bowed to popular hostility toward the doctors.  When the time came to fill vacant seats on the Board, the members gently suggested to the Governor that while the board required citizens of “intelligence, probity and public spirit,” they preferred that the new members not include any practicing physicians or established medical preceptors. As they explained, the “collision of medical theories, instead of illuminating, may envelope the true origin of the calamity,” and that distorting effect would only be amplified by “the tenacity of science, and illusions of theory.”[5]  The Board, they reasoned, would be paralyzed by the bitterness that had developed among Philadelphia’s doctors, and be unable to adopt prudent policies that could meet the public need or satisfy the public’s suspicion. In other words, the Board decided that the public health was too important to leave up to the doctors.

  • Taken as the story of a decade rather than a year, Philadelphia’s yellow-fever crisis teaches lessons for 2020 that are more complex and less comforting than Carey’s version:
  • The shock of a new threat can curdle into frustration with a familiar hazard.
  • In a contest with political expediency, expertise won’t always win.
  • The populace can come together, but its patience is finite.

No one yet knows when this wave of COVID-19 might end, or how many more waves there may yet be. But as the pandemic continues, commitment to the public good—such as it is—will come under increasing strain, and experts must be ready to answer skepticism with something better than “Raving and Disputing.”


[1]    Matthew Carey, A Short Account of the Malignant Fever Lately Prevalent in Philadelphia (Philadelphia, 1793); J. H. Powell, Bring Out Your Dead: The Great Plague of Yellow Fever in Philadelphia in 1793 (Philadelphia, 1949).

[2]    This interpretation of Carey is indebted to Sally F. Griffith, “A Total Dissolution of the Bonds of Society: Community Death and Regeneration in Mathew Carey’s Short Account of the Malignant Fever,” in A Melancholy Scene of Devastation: The Public Response to the 1793 Philadelphia Yellow Fever Epidemic, ed. Billy G. Smith and J. Worth Estes (Canton, MA, 1997). See also Jacqueline Bacon, “Rhetoric and Identity in Absalom Jones and Richard Allen’s Narrative of the Proceedings of the Black People, During the Late Awful Calamity in Philadelphia,” Pennsylvania Magazine of History and Biography 125, no. 1 (2001), 61–90.

[3]    Simon Finger, The Contagious City: The Politics of Public Health in Early Philadelphia (Ithaca, NY, 2012), 128–29.

[4]    Thomas Apel, Fevered Bodies, Enlightened Minds: Science and the Yellow Fever Controversy in the Early American Republic (Redwood City, CA, 2016). See also Finger, The Contagious City, 124-130.

[5]    Finger, The Contagious City, 145-146.

18 May 2020

About the Author

Simon Finger teaches at The College of New Jersey.

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