In 1793, Philadelphia, then the capital of the United States, faced a devastating yellow fever epidemic. Between August and November, this mysterious illness claimed over 5,000 lives from a population of 50,000, crippling commerce and government functions. The sudden outbreak instilled widespread fear, causing over 20,000 residents, including many of the city’s wealthy, to flee to the countryside. This mass exodus left those remaining in a state of confusion and desperation, highlighting the urgent need for medical intervention against an unknown and terrifying disease. Physicians of the era grappled with limited understanding and often aggressive, unproven treatments.
Prevailing Medical Theories
Medical understanding in the late 18th century was rooted in long-standing theories. The humoral theory, a dominant concept, posited that the human body comprised four primary fluids: blood, phlegm, yellow bile, and black bile. Health depended on their balance, and physicians aimed to restore this equilibrium through various interventions.
Another belief was the miasma theory, which suggested diseases like yellow fever were caused by “bad air” or noxious vapors from decaying organic matter. Philadelphia’s unsanitary conditions, with open sewers and accumulated refuse, seemed to support this theory, influencing efforts to clean the city for disease control.
These theories contributed to “heroic medicine,” an aggressive treatment approach prevalent from 1780 to 1850. This method advocated vigorous interventions like bloodletting and purging to “shock the body back to health.” Symptoms were often seen as complications to be suppressed rather than the body’s attempt to fight illness, leading to the use of powerful drugs in large dosages. The core idea was to deplete the body of perceived toxins or excess humors to restore balance.
Benjamin Rush’s Aggressive Regimen
During the 1793 epidemic, Dr. Benjamin Rush, a prominent physician and signer of the Declaration of Independence, became a leading figure in treating yellow fever patients. Convinced that aggressive measures were necessary to combat the severe illness, Rush adopted a therapeutic approach centered on rapid depletion of the body. His methods were largely influenced by the prevailing heroic medicine and humoral theories of the time.
Rush’s regimen primarily involved extensive bloodletting, also known as phlebotomy. He believed that by removing large quantities of blood, he could reduce “vascular tension” and clear the body of disease-causing agents. Patients sometimes had dozens of ounces of blood removed, with some accounts suggesting as much as 80 ounces over five days in severe cases. This was a far more aggressive application of bloodletting than typically practiced at the time.
Alongside bloodletting, Rush vigorously employed purging to expel what he considered to be accumulated toxins. His preferred purgatives included calomel (mercurous chloride) and jalap, a powerful laxative. These substances were administered in large doses to induce profuse bowel movements and vomiting. Rush’s rationale was that these harsh treatments were necessary to cleanse the body and restore its natural balance. His personal recovery from yellow fever after undergoing his own rigorous treatment further solidified his conviction in his methods. Rush’s influence and the widespread adoption of his techniques made his approach the most prominent treatment during the crisis.
Alternative Medical Approaches
While Dr. Benjamin Rush championed aggressive treatments, other physicians during the 1793 yellow fever epidemic advocated for less invasive approaches. Dr. Jean Deveze, a French physician experienced in treating yellow fever in Saint-Domingue (now Haiti), offered a contrasting philosophy at the Bush Hill hospital. Deveze believed in supportive care, focusing on strengthening the body’s natural systems rather than aggressively depleting them.
Deveze’s treatment regimen included rest, proper hydration, and less invasive methods such as frequent cold baths to reduce fever. He also prescribed stimulants, tonics, cordials, and cinchona bark, which was the source of quinine. Quinine was used by some, though its effectiveness specifically for yellow fever at the time was debated, as it was primarily known for treating malaria. Deveze explicitly criticized Rush’s methods, describing them as “a scourge more fatal to the human kind than the plague itself.”
Other physicians, like Dr. William Currie and David Nassy, also employed mild treatment approaches. These alternative methods represented a philosophical divergence from heroic medicine, emphasizing a more gentle approach to patient care, though their efficacy was not fully understood.
Contemporary Perceptions of Treatment Outcomes
The efficacy of the various yellow fever treatments in 1793 was a subject of intense debate among physicians and the public. This lack of consensus reflected the era’s limited scientific understanding. Dr. Benjamin Rush, despite his aggressive methods, asserted that his treatments were highly successful, claiming to have saved thousands of lives. He believed his approach, particularly the combination of bloodletting and purges, was the key to conquering the disease.
However, Rush’s methods faced significant criticism from his peers, leading to heated controversies within the medical community. Critics, including figures like Alexander Hamilton, pointed to the harshness of his treatments and argued that they potentially increased suffering and fatalities rather than curbing the disease. The high mortality rate, even among those treated by Rush, cast doubt on the perceived success of his regimen.
The debates extended beyond professional circles, influencing public opinion and even leading to Rush’s resignation from the Philadelphia College of Physicians in 1793 due to the controversy. While many believed the aggressive interventions were saving lives, others remained skeptical, with some satirists of the time directly linking the high death tolls to Rush’s remedies. This period highlighted a profound lack of understanding regarding the disease’s true cause and effective treatment, leading to conflicting assessments of outcomes.