Contexts and Causes

We [doctors] are employed in ... a necessary calling that enforces to us the weakness and mortality of human nature. This earthly frame, a minute fabric, a center of wonders, is forever subject to Diseases and Death. The very air we breathe too often proves noxious, our food often is armed with poison, the very elements conspire the ruin of our constitutions, and Death forever lies lurking to deceive us.

BENJAMIN RUSH, 1761

What caused yellow fever? The question was on most everyone's mind in the United States' capital in the winter of 1793, as legions of Philadelphians, some twenty thousand in all, trudged back into the city they had abandoned only months before. Those seeking answers would have found them, lots of them; indeed, more than they would have liked. People were talking and the newspapers were all abuzz with word of the disease. According to Mathew Carey, "almost all" Philadelphians believed that the disease came from abroad, probably along with the two thousand French-speaking refugees from Saint-Domingue who had arrived in the ports of Philadelphia earlier that summer, some of them allegedly infected with yellow fever. Others implicated the conditions of the city: the stinking cesspools, the decaying animal carcasses, rotten vegetables, and stagnant pools of water that bred pestilential miasma. A pseudonymous writer for John Fenno's Gazette of the United States, masquerading as William Penn, the founder of Philadelphia writing from the "Elysian fields," chided his contemporaries for straying from his plan for the city. "It was my intention in laying the plan of Philadelphia," the ghost of Penn wrote, "to provide for the health as well as the beauty and conveniency of the place" (Figure 1.1). The author, evidently a localist, blamed city-dwellers for cutting down trees, narrowing the streets, and building where they should not. "Had you preserved my plan," the imposter informed his readers, "you might have avoided the mischief which has now befallen you."

Those learned in science and medicine set out to solve the puzzle. Benjamin Rush opened the commentary. The forty-eight-year-old professor of the theory and practice of medicine at the University of Pennsylvania was one of the foremost physicians in the United States, and an established figure in the nation's intellectual life. Born in Byberry, Pennsylvania, on Christmas Eve 1745, Rush studied medicine at the University of Edinburgh under the illustrious William Cullen. Once back in Philadelphia, Rush became the professor of chemistry at the College of Philadelphia, and he joined the American Philosophical Society. He later served in the Continental Congress and signed the Declaration of Independence. Rush labored hard to improve the medical and scientific reputation of Philadelphia, a city he rather hopefully deemed the "Edinburgh of America." To that end, he helped form the College of Physicians of Philadelphia in 178