Philadelphia’s plague

Hayat El Boukari
Tetouan, Morocco


On August 3, 1793, a young French sailor rooming at Richard Denney’s boarding house on north Water Street in Philadelphia was desperately ill with a fever. Eighteenth century record keeping was not very precise, no one bothered to write down his name, and he was a poor foreigner and not the sort of person who would draw much attention. All that is known is that his fever worsened, he had violent seizures, and a few days later he died. Other residents at Denny’s would follow him to the grave — eight deaths from the same symptoms within one week — but the city took no notice that the church bells were tolling more often than usual. Nobody knew that the killer was already moving through their streets, an invisible stalker who would go from house to house until it had touched everyone, rich or poor, in some terrible way.1

On August 19 it was clear that the thirty-three-year-old Catherine was dying, horribly and painfully, muttering between agonized gasp and groans that her stomach felt as if it were burning up. Every ten minutes or so her moaning would stop, and then she would vomit foul black bile. Two neighborhood doctors were in charge of her: Dr. Hugh Hodge, whose own daughter had died of the same fever just days earlier, had been a surgeon during the Revolutionary War; and Dr. John Foulke, a fellow of Philadelphia’s prestigious College of Physicians and a member of Pennsylvania Hospital Board.1

Dr. Hodge and Dr. Foulke did what they could for their patient. They gave her cool drinks of barley water and apple water to reduce the fever, and red wine with laudanum to help her rest. Nothing worked; her condition worsened, her pulse slowed, her eyes grew bloodshot, her skin took on a pale yellow color, and more black vomit came spewing forth. In desperation the two physicians sent for their highly esteemed colleague Dr. Benjamin Rush, who in recent days had seen in that city an unusual number of cases of bilious fever, accompanied by symptoms of uncommon malignity.1

All three doctors recounted the symptoms they had seen. The sickness began with chills, headache, aching in the back, arms, and legs, a high fever, and constipation. After about three days the fever suddenly broke and the patient seemed to recover. But only for a few short hours. Then the fever shot up again; the skin and eyeballs turned yellow; the nose, gums, and intestines began to bleed; and the patient vomited stale, black blood. Finally, the pulse grew weak, the tongue turned a dry brown, and the victim became depressed, confused, and delirious.

Four plates showing the development of yellow fever. From the title: Observations sur la fièvre jaune, faites à Cadix, en 1819 / par MM. Pariset et Mazet. Authors: Etienne Pariset (1770-1847) and André Mazet (1793-1821). Credit: Wellcome Collection. CC BY 4.0.

Dr. Rush also noted tiny reddish eruptions on the skin (petechiae), chiefly on the arms but sometimes extending to the breast. Dr. Rush observed that they “resemble mosquito bites.” The symptoms he was seeing reminded him of a sickness that had swept through Philadelphia back in 1762, so he boldly announced that the disease he they now confronted was the dreaded yellow fever.1

 Putting the name yellow fever to the illness was not to be done lightly. Yellow fever could create panic anywhere. It appeared suddenly and killed at an alarming pace, its mortality rate often reaching fifty percent. What is more, the stench of the victims’ bodily evacuations and breath, the odor from their soiled clothes and bed linen, and even the air that escaped from their sick room was believed to spread the disease with lightning speed. Dr. Rush, in short, had just announced that Philadelphia was in the grip of a deadly, unstoppable plague.

It all had started in 1792, when the Hankey and two other ships carried nearly three hundred idealistic antislavery British radicals to Bolama, an island off the coast of West Africa. They hoped to establish a colony designed to undermine the Atlantic slave trade by hiring rather than enslaving Africans. Poor planning and tropical diseases, especially a particularly virulent strain of yellow fever likely contracted from the island’s numerous monkeys (through a mosquito vector), decimated the colonists and turned the enterprise into a tragic farce.2

For one of the first times in American history, blacks responded in print; Revd.s Allen and Jones published a pamphlet answering the charges; Courtesy of the Internet Archive

In early 1793, after most colonists had died and survivors had met resistance from the indigenous Bijagos for invading their lands, the Hankey attempted to return to Britain. Disease-ridden, lacking healthy sailors, and fearing interception by hostile French ships, the colonists caught the trade winds to Grenada. They and the mosquitoes in the water barrels spread yellow fever in that port and soon throughout the West Indies. By July 1973, a few months after the arrival of the Hankey, commercial and refugee ships carried passengers and mosquitoes infected with yellow fever to Philadelphia, the nation’s capital during the 1790s. It resulted in the yellow fever epidemic killing five thousand people and forcing tens of thousands of residents, including George Washington, Thomas Jefferson, and other prominent federal government leaders, to flee for their lives. The U.S. capital moved from Philadelphia to Washington, D.C. after this epidemic.2,3

This was only a few months before the British arrived to quell the slave rebellion in St. Domingue (now Haiti). The British and later the French military had their troops decimated by the disease — one reason why the slave revolution succeeded. The crushing defeat in the Caribbean helped convince Napoleon to sell the vast Louisiana Territory to the United States. He turned eastward to expand his empire, altering the future of Europe and of the Americas.

Among those who stepped forward to aid people and save the city were members of the newly emerging community of free African Americans. Led by Absalom Jones, Richard Allen, and Anne Saville, black Philadelphians volunteered to nurse the sick and bury the dead — both dangerous undertakings at the time. Many African Americans and physicians, exposed to yellow-fever infected mosquitoes, made the ultimate sacrifice as they died in disproportionately high numbers.

When a newspaper editor later maligned black people for their efforts, Jones and Allen wrote a vigorous response — among the first publications by African Americans in the new nation.

During the next decade, yellow fever afflicted every port city in the new nation. Epidemics also occurred in metropolitan areas throughout North and South America, the Caribbean, southern Europe, and Africa. Among other consequences, this disaster encouraged Americans to fear cities as hubs of death. The future of the United States, as Thomas Jefferson argued, would be rural areas populated by yeomen farmers rather than by people in teeming metropolises. The epidemics also helped solidify the decision of leaders of the new nation to move its capital to Washington D.C. and away from the high mortality associated with Philadelphia.2



  1. Jim Murphy. An American Plague: The True and Terrifying Story of the Yellow Fever. Houghton Mifflin Harcourt, 30 Sept. 2014
  2. Billy G. Smith. Ship of Death: The Voyage that Changed the Atlantic World. New Haven, CT: Yale University Press, 2013
  3. Molly Caldwell Crosby. The American Plague: The Untold Story of Yellow Fever the Epidemic That Shaped Our History Berkley Books, New York



HAYAT EL BOUKARI, MD, is a general practitioner who graduated from the Faculty of Medicine of Rabat in Morocco in 2017. Hayat was born and raised in the north of Morocco and is passionate about medicine and interested in exploring its history and art.


Highlighted in Frontispiece Volume 11, Issue 4 – Fall 2019

Spring 2019  |  Sections  |  Infectious Diseases