HOST: The year is 1793. I am standing on the corner of Water and Arch Streets in Philadelphia. It is late August, and the heat is oppressive—a thick, wet blanket that traps the smells of the river, the rotting garbage, and something else... something metallic and sweet. The smell of sickness.
Usually, this city—the capital of the United States—bustles with the sounds of carts, merchants, and politicians. It is the heart of the new American Republic. But today, the silence is deafeaning. Windows are shuttered tight. The only movement comes from a wooden cart rattling down the cobblestones, carrying a pine coffin.
I’m here to find the man at the center of the storm. The most famous doctor in America, a signer of the Declaration of Independence, and the man currently fighting a war against an invisible enemy. I’m here to meet Dr. Benjamin Rush.
I find him in his study on Walnut Street. The room is chaotic—stacks of letters, medical journals, and jars of white powder cover every surface. Dr. Rush looks exhausted. His wig is askew, his eyes are rimmed with red, and there is a frantic energy to his movements. He motions for me to sit, keeping a handkerchief soaked in vinegar pressed near his nose.
HOST: Dr. Rush, thank you for speaking with me. The city... it feels abandoned.
DR. BENJAMIN RUSH: Abandoned? No, sir. It is besieged. Twenty thousand have fled—half the population! The federal government is gone. Washington, Jefferson... they have all retreated to the countryside. But the poor remain. And the dying remain. And I, sir, shall remain.
HOST: You describe this as a siege. But who, or what, is the enemy? There are rumors swirling in the coffeehouses—or the ones that are still open—that this plague was brought here by the refugees fleeing the revolution in Saint-Domingue.
DR. BENJAMIN RUSH: [Scoffs] A convenient scapegoat for the ignorant! They blame the French refugees; they blame the foreign ships. But I tell you, the corruption is here. It is local.
HOST: Local?
DR. BENJAMIN RUSH: It is the miasma, sir! The putrid exhalations of the earth. I have traced the origin myself. There was a shipment of coffee left to rot on Ball’s Wharf near Arch Street. It lay there in the sun, putrefying, releasing a noxious gas into the air. That is the source! The atmosphere of our city has become constitutionally predisposed to disease. We are breathing in death.
HOST: That is a terrifying thought. But the symptoms... they are horrific. I’ve heard reports of victims turning yellow, vomiting black fluid.
DR. BENJAMIN RUSH: The Black Vomit. Yes. It is the final stage. The eyes burn red, the skin takes on the saffron hue of the jaundice, and the pulse... the pulse becomes a frantic, tense cord vibrating under the skin. It is a ferocious fever, sir. It seizes the body and does not let go.
HOST: And your treatment? You’ve faced significant criticism from other physicians in the College of Physicians. They say your methods are... too aggressive.
DR. BENJAMIN RUSH: Aggressive? The disease is aggressive! You do not fight a lion with a feather! You must be bold! Desperate diseases require desperate remedies.
HOST: What exactly is the regimen?
DR. BENJAMIN RUSH: Depletion. We must purge the body of the morbid excitement. I administer mercury—calomel—and jalap to cleanse the bowels. And then, the lancet. We must bleed the patient.
HOST: Bleed them? Even when they are already weak?
DR. BENJAMIN RUSH: Especially then! I have taken up to eighty ounces of blood from a single patient. It calms the pulse. It breaks the fever. I have seen it work! I have saved hundreds!
HOST: But critics say you are bleeding them to death.
DR. BENJAMIN RUSH: [Voice rising] Let them talk! While they flee to the safety of the country, I am here visiting a hundred patients a day. My own sister has died of this. I myself have fallen ill and cured myself with this very method. I will not let my patients die for lack of courage to treat them.
HOST: Dr. Rush, I’ve noticed that many of the nurses tending to the sick are Black. Can you tell me about their role?
DR. BENJAMIN RUSH: Ah, yes. The Free African Society. I wrote to Richard Allen and Absalom Jones. It was... it was believed by many that the constitution of the African was immune to this yellow fever. I implored them to help us.
HOST: And were they immune?
DR. BENJAMIN RUSH: [Quietly] We were wrong. Tragically wrong. They die just as we do. Yet, they continue to serve. They nurse the sick, they bury the dead when no white man will touch the corpses. They are performing a Christian duty that puts the rest of this city to shame.
HOST: It seems the social fabric of Philadelphia is unraveling. I saw a man collapse on the street earlier, and people crossed to the other side to avoid him.
DR. BENJAMIN RUSH: Fear, sir, is as contagious as the fever. Husbands leave wives. Parents abandon children. The veneer of civilization is thin. When death walks the streets, we see the true nature of men. Some become saints, like those in the African Society. Others... others become savages.
HOST: How does this end, Doctor? The death toll is rising every day. The church bells have stopped ringing because they would never cease.
DR. BENJAMIN RUSH: It ends when the air clears. We need the frost. The cold is the only thing that seems to scour the atmosphere of this pestilence. Until then, we bleed, we purge, and we pray. Now, if you will excuse me, I have patients waiting. The list is long, and the day is short.
HOST: I watch him gather his bag—his lancets, his mercury powders. He looks like a soldier marching into a battle he cannot possibly win, armed with weapons that might be doing more harm than good. But his conviction is absolute.
I step back out onto the street. The sun is setting, casting a sickly yellow light over the empty market stalls. In the distance, I hear the rumble of the death cart again.
History tells us that Dr. Rush was wrong about the coffee. He was wrong about the treatment. And he was wrong about the transmission—it wasn't the air, but the Aedes aegypti mosquito, breeding in the stagnant water barrels of the city, that spread the virus.
But standing here, in the heat and the stench of 1793, you can’t help but feel the terror. This is a city fighting a ghost. It will take a hard frost in November to finally kill the mosquitoes and end the epidemic. By then, five thousand people—ten percent of the city—will be dead.
For now, Philadelphia waits. And bleeds.
This is the Time-Traveling Journalist, signing off from the fevered capital.
Backgrounder Notes
As an expert researcher and library scientist, I have reviewed the article concerning the 1793 Yellow Fever epidemic in Philadelphia. Below are key historical and medical concepts from the text with accompanying background details to provide deeper context for the reader.
Key Concepts and Backgrounders
Dr. Benjamin Rush (1746–1813) A prominent Founding Father and signer of the Declaration of Independence, Rush was a civic leader and the most influential physician in early American history. While he was a humanitarian who advocated for public education and the abolition of slavery, his medical reputation remains controversial due to his devotion to "heroic medicine," which favored aggressive treatments like heavy bloodletting.
Miasma Theory Prevailing until the late 19th century, miasma theory held that diseases were caused by "bad air" (miasmata) emanating from rotting organic matter, stagnant water, or filth. This belief led 1793 officials to focus on cleaning docks and streets rather than controlling the insect populations that were actually spreading the virus.
Saint-Domingue (Haitian Revolution) At the time of the epidemic, the French colony of Saint-Domingue (now Haiti) was in the throes of a massive slave uprising and revolution. Thousands of refugees, both white planters and enslaved or free Black people, fled the island for Philadelphia, unintentionally bringing the yellow fever virus and the mosquitoes that carry it in the holds of their ships.
Yellow Fever (The "Black Vomit") Yellow fever is a viral infection that, in severe cases, causes high fever, jaundice (yellowing of the skin and eyes), and internal bleeding. The "black vomit" mentioned in the text is a symptom caused by blood hemorrhaging into the stomach, which is then partially digested and expelled.
Calomel and Jalap These were the primary ingredients in Dr. Rush’s "ten-and-ten" purgative powders. Calomel is a toxic mercury-based compound used as a laxative, while jalap is a powerful purgative derived from the root of a Mexican plant; together, they were intended to "cleanse" the body of disease through extreme bowel movements.
Bloodletting (The Lancet) Based on the ancient medical theory of the four humors, bloodletting involved using a small surgical knife called a lancet to drain blood from a patient. Dr. Rush believed that "depleting" the body of excess blood would reduce the "morbid excitement" of a fever, though in reality, it often weakened patients and hastened their deaths.
The Free African Society (FAS) Founded in 1787 by Richard Allen and Absalom Jones, the FAS was the first independent Black mutual aid society in the United States. During the 1793 crisis, the society’s members performed nearly all the city's essential nursing and burial work, providing a heroic level of care while facing intense racial prejudice.
Aedes aegypti This is the specific species of mosquito that acts as the primary vector for transmitting the yellow fever virus to humans. Because these mosquitoes breed in small amounts of stagnant water (like rain barrels and gutters) and thrive in warm, urban environments, they were the invisible engine behind the 1793 epidemic.
The "Hard Frost" The article notes that the epidemic ended with the arrival of cold weather. This is because Aedes aegypti mosquitoes cannot survive freezing temperatures, and a hard frost kills the adult insect population and prevents the further transmission of the virus until the following spring.
