U.S. National Institutes of Health

Yellow fever ravaged Philadelphia in 1793. The deadly disease touched nearly everyone in the city: young and old, white and African American, wealthy and poor, religious and secular.

No one really knew what caused the disease or how to treat it.

As yellow fever consumed Philadelphia, politicians debated the disease’s origins, its treatment, and preventative measures. Secretary of the Treasury Alexander Hamilton, a prominent Federalist, believed that newly arrived, white, French refugees fleeing the revolution in Santo Domingo (now Haiti) were the source of the disease. Hamilton and other Federalists favored actions like closing the ports and restricting immigration to stem the epidemic. By publishing his opinions about the epidemic and its treatment in newspapers, Hamilton turned what had been a medical question into a political dispute.

"A new order of things is rising in medicine, as well as in government."
- Dr. Benjamin Rush

The medical community disagreed on the causes and treatment for yellow fever. Dr. Benjamin Rush, a prominent physician, signer of the Declaration of Independence, and opponent of Hamilton’s politics, emerged as the figurehead for the faction of physicians who believed the epidemic developed from miasma, or impure air, in Philadelphia. Rush supported efforts to improve sanitation to eliminate yellow fever.

Rush’s ideas about the treatment of yellow fever were controversial among both physicians and the public. Although he drew on a medical tradition that employed aggressive bleeding, purging, and large doses of mercury to treat disease, these treatments were falling out of favor. Hamilton and his peers tended to favor the gentler bark and wine cure, sometimes called the “West India cure.” Because neither treatment plan was particularly effective, the decision to choose one or the other became linked to political preferences.

Within a month of yellow fever’s arrival in Philadelphia, the city, state, and federal governments had essentially stopped functioning. A group of private citizens came together to organize desperately needed relief services. Known simply as “The Committee,” this group ran Bush-Hill Hospital, operated an orphanage, and provided supplies to the poor.

Philadelphia’s free African American residents kept the city from total collapse. At the outset of the epidemic, white physicians erroneously thought that African Americans were immune from yellow fever and called on them for help. African Americans provided the bulk of the nursing care and manual labor required to sustain the city, although they were excluded from the official work and leadership of The Committee.

A century lay between Dr. Benjamin Rush’s efforts on behalf of the sick in 1793 Philadelphia and Dr. Walter Reed’s discovery in 1900 that mosquitoes transmit yellow fever. In that time, the disease stirred panic and inspired scientific research in equal measure. Everyone from elite physicians to quacks, private citizens to elected officials and military officers had an opinion about yellow fever. After scientists confirmed that mosquitoes can transmit yellow fever and other diseases, mosquito control emerged as an important public health measure. The quantity and variety of writing on yellow fever indicates the extent to which it occupied the thoughts of American physicians and shaped the development of the nation’s public health infrastructure.

"I have myself been attacked with the reigning putrid fever."
- Alexander Hamilton