Contagion Plagues the Capital

The Arch Street docks, Philadelphia

A mysterious illness struck the country, entering through the ports from abroad, and people died in huge numbers. It attacked the nation’s capital first. The federal government was completely unprepared for the mass chaos and collapsed. The year was 1793. The capital was Philadelphia. The president was George Washington. He did what most of the government did. He fled.

Yellow fever—for that is the contagion’s name—originated in the Caribbean. Congress ended its session of June 1793, and sometime that summer a boat (likely several of them fleeing unrest in Barbados) arrived from the islands with sick passengers. It is probable that mosquito larvae tagged along in the ships’ water barrels and the adult insects quickly began contracting and passing along yellow fever. Philadelphia, surrounded by swampy ground, was already thick with the pests and enduring a particularly hot, humid summer.

Bush Hill, along the Schuylkill River–later a fever hospital

In fairness to President Washington, there were neither policies nor precedents for any sort of role for the federal government in an epidemic. They had no real authority to act. Besides, Washington and other federal officials had already planned to leave Philadelphia. Wealthy Philadelphians routinely left the city for their country homes along the Schuylkill River, many of which still exist in what is now Fairmount Park, in the heat of the summer. Washington himself planned to leave in early September and expected to lay the cornerstone for the new U.S. Capitol in the city that would be named after him on September 17.

Benjamin Rush by Charles Wilson Peale


By early August the famed physician Benjamin Rush (who had signed the Declaration of Independence almost twenty years before) and some of his colleagues realized something wasn’t right. People were dying. The first confirmed case of yellow fever was identified on August 19. The death toll, ten or more a day at the start, quickly mounted. By August 25 panic set in; Rush and the college of physicians advised those who could leave to do so and mass exodus began. Ultimately, 17-20,000 out of a total population of the area estimated at 50,000 fled the area.

Congress moved to Germantown, PA.  On September 6 Alexander Hamilton sent word to the president that he would not be able to attend a cabinet meeting because he and his wife had yellow fever. Washington left on September 10, eager to get his wife and two grandchildren out of the city.

Business came to a standstill. Anyone who hadn’t left by mid-September however, found it hard to do so due to lack of transportation, blocked roads and opposition in outlying areas. By October deaths were running 100 or more a day, and the descriptions of the misery are heart rending. The symptoms of yellow fever include not only fever and aches but jaundice, hemorrhage, and black vomit, i.e. bloody vomit. Many went without care. Dead lay in houses across the city.

In this environment, peoples’ reactions were complex. There were a hundred or so physicians in the city at the start; some fled, others died. Benjamin Rush stayed. By October he estimated there were three physicians left to treat the sick. Some saw him as a hero because he stood his ground, provided leadership and a calming influence for the sufferers. He contracted the disease himself, recovered and went back to work.

Others saw Rush as guilty of manslaughter due to his stubborn insistence purging and bleeding patients. He had no knowledge of microbiology, of course, and suspected the rotting garbage on the docks might be to blame for the contagion. A clean-up began on his orders; it didn’t help. Because people who contract yellow fever have lifetime immunity, many from the islands were immune, and Rush mistakenly concluded that people of African descent were less susceptible to the disease, and recruited them to assist.

Bishop Richard Allen

Black leaders Reverend Richard Allen and Absalom Jones, leaders of the Free African Society who apparently believed him, responded to Rush and the mayor’s call for African Americans to nurse and treat the infected and to bury the dead, leading their people into heroic roles as caregivers. Many of them fell ill; over two hundred died.

The mayor of Philadelphia, Matthew Clarkson stayed. He and a committee of twenty-six men organized  to feed those who could not, to care for orphans, and to create a fever hospital. They assigned the job of carrying out the dead to Allen’s free Africans. Most others refused to do it.

Wealthy French businessman Stephen Girard who easily could have fled the city stayed. In mid-September he volunteered to take over management of the fever hospital at Bush Hill, a mansion that once housed John Adams when he was vice-president, which had been turned into a makeshift hospital, and which was in deplorable condition. Peter Helm, a barrel maker, came to his assistance. The took control, removed filth, bought and repaired beds, created separate spaces for recovering patients and for women, hired nurses at their own expense, and worked side by side with others nursing patients. Girard recruited French doctors from Sainte-Domingue whose methods proved superior.

The scourge lasted over 100 days and the statistics are grim. Experts put the number of dead at 5,000—10% of the pre-fever population or 17% of those who remained. The city of Philadelphia had 1,525,000 people in 2010. A similar catastrophe today would result in over 150,000 deaths.

When the onset of winter finally brought the epidemic to a halt, printer Mathew Carey published A Short Account of the Malignant Fever which attacked Rush’s methods, lauded Stephen Girard as a hero, and unfortunately maligned the Free African Society as villains, calling them greedy. Allen and Jones published their own account, Narrative of the Proceedings of the Black People During the Late Awful Calamity in Philadelphia in the Year 1793; And a Refutation of Some Censures Thrown upon Them in Some Late Publications.

Of course, yellow fever didn’t go away. Philadelphia experienced periodic rounds, but growing immunity in the population of survivors made successive bouts less horrific. New York experienced a similar epidemic the following year, and Bellevue Hospital served as a fever hospital. Many southern cities—Charleston, Memphis, New Orleans notably—suffered periodic yellow fever epidemics throughout the 19th century. Girard’s vociferous opposition to Rush’s methods, political squabbles about division of responsibility and methods echoed down the century.

Walter Reed

Pasteur’s theories of germ disease brought progress in the latter part of that century, but it was Walter Reed, an army surgeon, who in 1900 finally confirmed that the villain in the transmission of yellow fever was the little mosquito, leading to prevention. Vaccines followed in the early twentieth century, now recommended only for those traveling to infected countries, none of them in North America. The world had one less scourge. Obviously it wasn’t the last.

As to Philadelphia, it had its round of illnesses, but the worst came in 1918. Poor understanding of virus transmission and political blindness prevented action at the approach of the Spanish Flu to the city. A massive parade occurred involving much of the population and within 72 hours, people were dying. 14,000 people died of the flu that year in conditions only marginally better than 1793. One hopes we’ve learned things—social distancing chief among them—since then.

Historical novels that use yellow fever as a plot point or central theme are abundant. One powerful example is Laurie Halse Anderson’s Fever 1793.











For more information see:

Anton, Howard; “Stephen Girard and the Yellow Fever Epidemic of 1793;” Stephen Girard Forgotten Patriot, n.d.;

Arnebeck, Bob; “George Washington and Yellow Fever;” Yellow Fever Casebook: Descriptions of historic yellow fever cases, especially in Philadelphia and New York in the 1790s, January 20, 2012.

Caplinger, Christopher; “Yellow Fever Epidemics,” The Tennessee Encyclopedia, n.d.;

Gum, Samuel L. “Philadelphia Under Siege: The Yellow Fever of 1793;” Pennsylvania Center for the Book: Summer 2010.

North, Robert L.; “Benjamin Rush, M.D.: Assassin or Beloved Healer;” Baylor University Medical Center Proceedings, Vol. 13, January 2000; referenced on PubMed: United States Library of Medicine of the National Institute of Health.

“The Yellow Fever Epidemic;” Richard Allen: Apostle of Freedom, an exhibit of The Historical Society of Pennsylvania, 2010.

Smith, Billy G.; “The First Yellow Fever Pandemic: Slavery and Its Consequences;” Books, Health, and History; New York Academy of Medicine, October 15, 2018.

Caroline Warfield works in an office near her adopted city of Philadelphia surrounded by windows where she lets her characters lead her to adventures in England and the far-flung corners of the British Empire while she nudges them to explore the riskiest territory of all, the human heart. Stories of the 1918 flu struck her forcefully while researching Christmas Hope in which the hero manages to get most of his men through the horrific Great War only to face the flu.