Reviewed by: Dennis Cornfield, M.D.

June 30, 2023

America’s First Plague, by historian Robert P. Watson (Lynn University, Boca Raton, FL), is the story of Philadelphia’s yellow fever epidemic of 1793. It explores the African origins of the epidemic, its mid-summer appearance in Philadelphia, its spread from the wharf to the entire city and beyond, and its disappearance with the first frost in November, 1793. Along the way, we meet the major actors in the drama: Dr. Benjamin Rush, whose tireless efforts to combat a disease whose cause was entirely unknown produced mixed results at best; Stephen Girard, the enormously wealthy merchant who stepped up to voluntarily manage the makeshift yellow fever hospital at Bush Hill for 60 consecutive days; Mayor Matthew Clarkson, “a symbol of strength and resolve,” who remained in the city while its government dissolved; Reverends Richard Allen and Absalom Jones, who rallied the city’s black community to serve as caretakers for the massive numbers of patients who were sick and dying.

The author treats us to countless vignettes and interesting numerical facts. Yellow fever is believed to have originated in Africa approximately 3,000 BC. It was first seen in the Western Hemisphere in the mid-1600s in the Yucatan peninsula. Approximately 20-25,000 citizens, or half the city’s population, evacuated Philadelphia during the epidemic. In 1900, Maj. Walter Reed and his colleagues proved that the infected female mosquito, Aedes aegypti, transmits the yellow fever virus. This mosquito lays 350-700 eggs at a time.

In a foreshadowing of the 2020 Covid-19 pandemic, the 1793 yellow fever epidemic became politicized. “The 2 fledgling parties [Republicans (eg, Thomas Jefferson) and Federalists (eg, Alexander Hamilton)] squared off over the causes of and treatments for the disease, with the Republicans supporting Rush’s foul air (miasma) theory and his advocacy of aggressive purging and bleedings,” while the Federalists felt the disease had arrived from the West Indies and was best treated with gentler methods like bathing and herbs. As the author points out, one negative sequel of the epidemic was the solidification of the political parties against each other. On the positive side, the city’s streets and wharfs underwent a vigorous cleaning when the epidemic was over, and a robust public water system was created, under the direction of Benjamin Latrobe.

As informative and entertaining as this book is, it has some problems. In the chapter on the hospital at Bush Hill, the author leaves the distinct impression that Stephen Girard, the hospital’s chief manager, found four doctors to work part-time at the hospital. Later, the author mentions a meeting wherein one of the four doctors, Dr. Philip Syng Physick, proposes that the medical work be split between himself and Dr. Devèze, Girard’s hand-picked physician from Saint-Domingue (present day Haiti). In point of fact,^1,2 the four doctors were working at Bush Hill when Girard arrived, and Girard was annoyed by their infrequent attendance at the hospital (total of 12 visits in 2 weeks among all four doctors combined) and by their aggressive, Benjamin Rush-like approach to treatment of yellow fever. In addition, the meeting mentioned above was only one of multiple meetings held over a 5-day period, with the final outcome showing Dr. Devèze as the sole physician-in-charge (he was soon joined by Dr. Benjamin Duffield) and Dr. Physick completely out of the picture.  

A recurring theme in this book is the perceived arrogance and egotism of Benjamin Rush, which the author believes was a hindrance to Rush’s acceptance of any form of treatment of yellow fever other than his own, namely bleeding and purging (this author is not the first to suggest that Rush may have killed more patients by his aggressive approach than he healed). Four or five statements to this effect would probably have sufficed, but instead there seem to be dozens (I did not count). To be fair, the author always presents a balanced picture when he is critical of Rush, pointing out his unquestioned contributions to medicine and psychiatry.

The author sometimes gives the appearance of stretching his medical knowledge a bit too far. A sentence early in the book begins “Etiology, a branch of medical science,..” With regard to physical findings in yellow fever, he says that petechiae are “reddish pinpoint spots on the skin, usually the result of bleeding within the mucous membrane.”  He further states that Rush’s observation that petechiae (pinpoint hemorrhages in the skin or mucous membranes) resembled insect bites “should have helped him identify the true cause” of yellow fever, and that Rush “never put one and one together to identify the cause of the disease.” Is the reader truly meant to believe that the great Benjamin Rush should have equated appearance with causality, particularly when it took another century to prove the relationship between a mosquito and yellow fever? With reference to Rush’s purging, we see the statement  “Of course, this elixir [calomel and jalap] was killing his patients and caused severe vomiting and diarrhea.”  In a discussion of Dr. Jean Devèze at Bush Hill hospital, it is claimed that Devèze’s “efforts were vastly more humane and effective [my italics] in alleviating the suffering”, as if a true comparison of efficacy were even remotely possible.

Although the style of writing in this book is generally straightforward and clear-cut, there are sentences which are uncharacteristically awkward and ambiguous. Here are 2 examples of a confusing sentence followed by a short, clarifying sentence. Both relate to the hospital at Bush Hill:

     “One of the first priorities, Girard noted, was that ‘the sick may probably be reduced for want of suitable persons to superintend the hospital.’  They needed quality, caring physicians and nurses.” 

    “And so, despite the enlightened leadership at Bush Hill and Herculean efforts from the staff, the fever hospital was still overrun with cases and a constant stream of new patients; likewise, the capital city had largely come to a standstill in terms of public services. Help was needed.”

 There are several other problems which are difficult to categorize. The title of the book is “America’s First Plague” (italics are mine).  America and its native populations were overrun by smallpox earlier in the 18th century, and Philadelphia itself had experienced more than one yellow fever epidemic prior to 1793. The image on the book’s jacket is that of Stephen Girard carrying a yellow fever patient to his carriage, but there is no identification of the image either on the jacket or within the book. Appendix A is a useful timeline of events, with each year noted in bold numbers, but “1793”, the year of the epidemic, is inadvertently omitted. The map of Philadelphia (Appendix B) is poorly reproduced. Even with the use of a magnifying glass, the tiny lettering is difficult or impossible to make out.  

Having pointed out the above problems, many of which are correctable with careful copyediting, I do not mean to leave a negative impression overall. This book is thoroughly researched, comprehensive, and quite enjoyable to read. It easily competes with John H. Powell’s Bring Out Your Dead² for the “all you ever wanted to know” prize. In addition to teaching us about the epidemic itself, the book sheds a lot of light on  the social, economic, and religious aspects of life in Philadelphia in the early years of the young republic.

References

1.Minutes of the proceedings of the Committee, appointed on the 14th day of September, 1793, by the citizens of Philadelphia, the Northern Liberties, and the District of Southwark, to attend to and alleviate the sufferings of the afflicted with the malignant fever, prevalent in the city and its vicinity; with an Appendix (pp. 24-28). (1848). Philadelphia, PA: Aitken & Son. [Available at https://archive.org/details/2567003R.nlm.nih.gov/page/n3/mode/2up]

2.Powell, J. H. (1949; Rprt. 1993). Bring Out Your Dead: The Great Plague of Yellow Fever in Philadelphia in 1793. Philadelphia: University of Pennsylvania Press.