Spot of Parchment, April 2020 - 1793 Yellow Fever Outbreak

I hope this post finds you safe and well. I struggle to put into words how much the world has changed in the last month. At least here in the DC-Virginia area, we are going to be locked down for two more months, so I’m trying to make the best of it.

As we all grapple with this new reality and its potential future consequences, I’ve received a lot of questions about the 1793 Yellow Fever outbreak and any similarities or differences to today’s situation. In some ways, the world is a remarkably different place and in other ways, not much has changed. I don't know if it's helpful to explore these past epidemics or not, but at the very least, I'd like to answer your questions.

First, some important context. As you may know, Yellow Fever is spread by mosquitoes (yet ANOTHER reason to hate them). It cannot be spread person-to-person, but if a mosquito bites an infected person and then bites a healthy person, it can transmit the disease. Because mosquitoes lay their eggs in standing water, they tend to thrive in hot, humid climates. Today, there is a vaccine that provides life-long protection, but even in the twenty-first century, there isn’t really a cure, other than hydration as much as possible.

In the eighteenth century, places like New Orleans, South American, Haiti, and large regions of Africa (places that never really have a hard freeze), suffered constant, lingering cases of Yellow Fever. Childhood cases of Yellow Fever are apparently milder and produce immunity, so in places prone to heavy mosquito density, the community tends to build up immunity over time. As a result, there weren’t as many large outbreaks, but rather chronic cases.

Places like Philadelphia, Baltimore, and New York, however, do have hard freezes and didn’t have the year-round plague of mosquitos. When those cities had particularly wet and humid summers, however, the mosquito population would spike and residents would be at higher risk if a person infected with Yellow Fever arrived in the city. These populations were especially prone to outbreaks because there was so little community immunization present.

That’s exactly what happened in Philadelphia in 1793. After a few hot, humid months, there was a deadly outbreak of Yellow Fever in the late summer and early fall. Between August 1 and November 9, around 5,000 people died—or around 10% of the city’s population of 50,000. The state and federal government (which was currently residing in Philadelphia) fled, along with most wealthy families that could take shelter in their country homes. The outbreak tapered off with the arrival of cold weather, and although there were several other outbreaks over the next few decades, the 1793 epidemic was one of the most severe in U.S. history.

So how does 1793 compare to today? Well first, eighteenth-century Americans had little understanding of modern medicine and had no clue where the disease originated. They blamed “miasmas,” our tainted air for spreading the disease. They were close; the standing water in which mosquitoes bred did tend to smell, but it wasn’t the odors or the air itself. The solution to the miasmas was hotly contested. Many Federalists, like Alexander Hamilton, thought immigrants and refugees from Haiti and France were bringing in the deadly miasmas on their ships. Republicans, like Thomas Jefferson and Benjamin Rush, blamed the unhealthy atmosphere in the city and wanted to undertake improvement projects, especially along the wharf where trash and refuse muddied the waters.

They were both right. At some point, someone (or a mosquito) infected with Yellow Fever had to have arrived in the city in order for mosquitoes to spread the disease. It’s unclear however, whether that person came from a southern city like Charleston or New Orleans, or came from Haiti or France. Once the infection arrived, the epidemic was exacerbated by the standing water and gross conditions in Philadelphia, which offered a playground of sorts to mosquitoes.

Congress was out of session, so most congressmen had returned to their homes for their regular summer visit. Many of the remaining state and federal officials fled the city, although Alexander Hamilton, Henry Knox, Thomas Jefferson, and Edmund Randolph lingered through September to dispatch matters in their departments. (Jefferson's house on the Schuylkill is pictured below. He lived here during the summer until he fled to Monticello). They all gathered again in Germantown, Pennsylvania in early November to regroup and finalize Washington’s annual address to Congress.

In the absence of government officials, healthcare for the sick was left to private citizens and volunteer organizations. Doctors, nurses, and laborers heroically tended to the sick and buried the dead. Free and enslaved African Americans played a particularly crucial role. Eighteenth-century doctors had observed that enslaved populations in South Carolina seemed immune to Yellow Fever, so they encouraged local black populations to volunteer their services. Unfortunately, many of the enslaved individuals in South Carolina had been forcibly brought over from Africa and carried immunity with them—the black community in Philadelphia was mostly American-born and without the same immunities. As a result, this population was particularly hard-hit.

Unlike in the twenty-first century, few contemporaries called for federal action. Frankly, they were mostly focused on trying to survive and care for their families. After the epidemic relented, Federalists and Republicans argued about how best to prevent future outbreaks. Federalists called for restrictions on immigration, which would have been a more national solution, while Republicans favored city improvements, which was obviously a state solution.

While Washington and the cabinet supported an expansive view of executive authority, no one encouraged the president to take action. Everyone agreed that disease was more of a local issue (based on my readings anyway), except for perhaps a day of fasting or prayer.

How then do 1793 and 2020 compare? Both then and now, political parties appear divided over the causes and solutions to the epidemics. The biggest difference between the two cases is the perspective on executive power. Today, disease prevention and public health are managed by executive agencies that report to the president. The heads of the departments sit on the National Security Council to ensure that global pandemics don’t threaten the nation’s security. As I said in my TIME op-ed, the founders couldn’t have envisioned the current pandemic we face, but they understood that certain crises called for federal action. While they weren’t prepared to call for that action in 1793, we can today.