Bring Out Your Dead: The Great Plague of Yellow Fever in Philadelphia in 1793 9780812291179

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Bring Out Your Dead

Publication of this book was made possible through the financial support of

Connaught Laboratories, Inc.

Bring Out Your Dead THE GREAT PLAGUE OF YELLOW FEVER IN PHILADELPHIA IN

1793

By

].H. POWELL Reprinted with a new Introduction by Kenneth R. Foster, Mary F.Jenkins, and Anna Coxe Toogood

PENN

University of Pennsylvania Press Philadelphia

University of Pennsylvania Press

Studies in Health, Illness, andCaregiving Joan E. Lynaugh, General Editor

A complete listing of the books in this series can be found at the back of this volume

Originally published in 1949 by the University of Pennsylvania Press Reprint edition copyright © 1993 by the University of Pennsylvania Press All rights reserved Printed in the United States of America U.S. Library of Congress Cataloging-in-Publication Data Powell,]. H. Oohn Harvey), 1914-1971 Bring out your dead: the great plague ofyellow fever in Philadelphia in 1793 / by].H. Powell; introduction by Kenneth R. Foster, Mary F.]enkins, Anna Coxe Toogood. p. cm. - (Studies in health, illness, and caregiving) Originally published: 1949. Withnewintrod. Includes bibliographical references and index. ISBN 0-8122-3210-0 (cloth). - ISBN 0-8122-1423-t (pbk.) 1. Yellow fever-Pennsylvania-Philadelphia-Historf-18th century. I. Title. II Series. RC211.P5P6 1993 614.5'41'097481109033-dc20 93-873 CIP 2nd paperback printing 1996

Contents List of Illustrations Introduction to the 1993 Edition Preface to the 1949 Edition Acknowledgments

Vll IX

XVll XXlll

''A Merry, Sinful Summer"

1

Infection in Water Street

8

Fever, Domestic and Foreign

29

Prevention, Personal and Civic

45

Crisis

64

Panic

90

"This Excellent Physician"

114

Bush Hill

140

The Committee

173

"Sangrado"

195

The Fugitives

216

Height of the Plague

233

Frost

260

Afterwards

280

Notes

287

Index

295

v

List ofIllustrations The City ofPhiladelphia, 1793 (drawn by John H. Geiszel)

pages XXIV-XXV

Benjamin Rush

facing page 18

Matthew Clarkson

facing page 19

Absalom Jones

facing page 96

Richard Allen

facing page 97

Tide page from book by Absalom Jones and Richard Allen

facing page 100

Cover of a 1793 pamphlet cataloging deaths from yellow fever

facing page 101

The Bush Hill mansion

facing page 144

Broadside bill of mortality

facing page 145

Stephen Girard

facing page 148

Israel Israel

facing page 149

VII

Introduction to the 1993 Edition In the summer of 1793, the first major epidemic of yellow fever in the United States ravaged Philadelphia, the nation's temporary capital and its largest, most cosmopolitan city. Philadelphia had the most prominent doctors in the New World, but still was not prepared for the crisis. The city's doctors knew little about yellow fever and quarreled publicly in the newspapers about its causes and treatment. By the end of the outbreak, nearly 5000 people were dead and nearly 200 children were orphaned. John Harvey Powell's Bring Out Your Deadvividly tells the tragic story. I ts original publisher, the University of Pennsylvania Press, has now reprinted the volume on the two-hundredth anniversary of the epidemic. The months leading up to the catastrophe were turbulent. France was at war with Great Britain, Holland, Spain, and Austria, and wanted the United States as its ally. The French Republic's new minister, Citizen Edmond Charles Genet, arrived in Philadelphia in May, 1793 and won enthusiastic public support. Recognizing the danger of war for the new nation, President Washington proclaimed the country neutral and gave Genet a cool reception. By summer, pro-French demonstrations had escalated and, as John Adams later recalled, "ten thousand people in the streets of Philadelphia ... threatened to drag Washington out of his house, and effect a revolution in the Government or compel it to declare war in favor of the French Revolution." The outbreak of yellow fever, Adams later maintained, scattered the rioters and spared the nation political upheaval. Also that summer, many French refugees arrived in Philadelphia from the island of Santo Domingo, fleeing a bloody slave rebellion. i:x

x

Introduction

They brought tales ofa pestilential fever that was devastating several islands in the West Indies. InJulythe fever broke out in Philadelphia. People developed violent fevers, yellow skin, and black vomit (from intestinal hemorrhages), and often died within a few days. When the epidemic faded in November, one-tenth of the city's residents had died and over 17,000 others had fled the city. Bring Out Your Dead describes the epidemic as it developed in those four terrible months. Great figures in American historyWashington, Adams, Jefferson, Hamilton-move through these pages (most of them left town as the epidemic spread). Its central figures are lesser known people who remained in Philadelphia to cope with the events as best they could. Many showed great courage and some became heroes. The book describes strong people who were forced to improvise in the time of overwhelming danger and great suffering and tragedy that befell the city. Benjamin Rush (1745-1813), the great American doctor, occupies center stage. Then in his late forties, Rush, as a famous patriot (a signer of the Declaration of Independence), philanthropist, teacher, and outspoken abolitionist, was a commanding presence in the Philadelphia medical community. With his wife and children safe in New Jersey, Rush remained in Philadelphia to battle the epidemic, treating as many as 120 patients a day. He soon became a popular hero for his obvious dedication and love. Rush was a tragic figure as well. So great was his confidence that he could tell a patient "you have nothing but a yellow fever" although his own sister and three of his apprentices died of the disease under his own roo£ "Hereafter my name shall be Shadrach, Mesach or Abednego," Rush later wrote (quoted by Powell), referring to the story in the Book of Daniel, "for I am sure that the preservation of these men from death by fire was not a greater miracle than my preservation from infection of the prevailing disorder." Rush passionately believed in the cure he developed early in the epidemic-radical bloodletting and strong purging with toxic mer-

Introduction

Xl

curic powders and other substances. Other doctors, some with experience with yellow fever in the West Indies, advocated the French treatment of rest, wine, and tonics. Rush tried this method early in the epidemic but lost three out offour of his patients; he also tried mild treatments with purgatives and bloodletting with disappointing results. Rush announced his radical method to other doctors and the public early in September, claiming complete success. The epidemic was both the high point of Rush's medical career and the beginning of his downfall. Stung by criticism by other physicians who disputed with him in the newspapers, Rush withdrew from the prestigious College of Physicians and by the end of the decade had stopped practicing medicine. Other central characters include the French merchant Stephen Girard and the German-descended cooper Peter Helm. The pair took charge of Bush Hill, an empty mansion that the city had converted into a hospital to care for the victims of the epidemic, after they witnessed the horrendous conditions there. Girard and Helm remained at their posts for the whole epidemic, despite the prevalent belief, not shared by Girard, that yellow fever was highly contagious. Consider also the Mrican American community, then comprising about 5 percent of the city's population. Mistakenly believing that blacks were immune to yellow fever, Rush called on the Free Mrican Society for help. Black Philadelphians, under the leadership of the former slaves Richard Allen and Absalom Jones, nursed the sick, carried the victims to Bush Hill, and buried the dead by night. They worked under appalling conditions, some for no pay. Responding to an unfair charge that some black nurses had exploited the sick for personal gain, Jones and Allen wrote a dignified and forceful defense in a pamphlet that was one of the first publications by Mrican Americans. About the same proportion of blacks as whites died of the fever. Bring Out Your Dead offers a brilliant portrait of medicine at the time of its birth in America. The epidemic occurred at the very end of the age of Enlightenment, which, in the medical sphere, was

xu

Introduction

marked by physicians' attempts to rationalize and systematize medical knowledge. Their theories were influenced by traditional doctrines, such as the theory that the body contains four "humors" (blood, phlegm, black bile, and yellow bile). Doctors sought to treat disease by restoring balance in the body using purges or cathartics, emetics, bleeding, and sweating. Rush and many other doctors also still clung to the theory that diseases were caused by impurities in the air such as vapors from decaying vegetable matter. Rush attributed the yellow fever outbreak to a shipload of spoiled coffee that lay abandoned and rotting on the Philadelphia waterfront. As the epidemic progressed, he came to think that all his patients had the same disease, and that the same drastic bleeding and purging would cure them all. Rush applied his cure at the first signs of disease, and he undoubtedly "cured" many people who did not suffer from yellow fever. The debates over the cause and treatment of yellow fever led to personal vendettas that rocked the medical world. Doctors eventually abandoned Rush's methods and theories on yellow fever, but during the 1790s he continued to have a strong following in Philadelphia. More than a century later, in 1901, Walter Reed and his colleagues proved that mosquitoes transmit yellow fever among humans. We still have no cure for the disease, and modern treatment is supportive only. In retrospect, the French method doctors practiced at Bush Hill does not look all that bad. As Powell relates in Bring Out Your Dead, Philadelphians rallied to fight yellow fever. The city cleaned up the streets and, after repeated outbreaks of the fever in the 1790s, in 1800 built the first major municipal water system in the nation. This did away with the need to store rainwater in barrels, and incidentally with many breeding grounds for mosquitoes. The city residents knew nothing of the role of mosquitoes in spreading disease, but many people associated the insects with the unhealthy summer climate when "autumnal fevers" and other illnesses were prevalent. They also worried about the pollution ofwells by privies and inadequate sewers. All these measures improved public health despite ignorance of the real causes of the disease.

Introduction

X111

Modern doctors have harshly judged Rush for blinding himself with his theories and for his poor powers of observation-for his unscientific approach. "There are few medical writers," one doctor wrote in 1929, "whose works are less worthy of perusal today than those of Rush. " Even Powell remarked that Rush had "no common sense." However, we should not judge the characters in this book from our present perspective. Certainly, Benjamin Rush was wrong, both in his understanding of the disease and in his methods of treatment. But his treatments-radical bloodletting and purging-were aggressive forms ofconventional therapies ofthe day. Rush pushed the boundaries of contemporary medicine to save his desperate patients. His controversial methods were far less radical in his day than, for example, the implanting of a baboon's heart into a human is today. Certainly, Rush deluded himself about his treatment. But, in our own recent past, doctors have performed too many hysterectomies and tonsillectomies, dispensed too many drugs of questionable effectiveness, with the mistaken belief that they were benefiting patients. Chemotherapy for cancer can be more devastating to a patient than bloodletting, and as uncertain of success. How will doctors evaluate our own cures two hundred years from now? By now, the biology of yellow fever is well known. It is caused by a virus that is transmitted among humans by the female of the mosquito species Aedes aegypti. Once infected, a mosquito remains a carrier for her entire life, which might run from spring to frost. The mosquitoes feed every third day (and are reportedly most savage in the afternoon), each time potentially transmitting the fever. Philadelphia is north of their natural range, but they are prolific breeders and once introduced would flourish there for a season-as happened repeatedly in the eighteenth and nineteenth centuries. Yellow fever was common in the United States until the twentieth century. In Philadelphia alone it struck in 1699, 1747, 1762, 1793,1794,1797,1798,1802, 1803, 1805, 1819, 1820, and 1853. It ravaged many other American cities as well, particularly in the south, where the last major outbreak was in New Orleans in 1905.

XlV

Introduction

It subsided for reasons that are not precisely known, long before vaccines appeared. Better public sanitation was surely a factor. The disease has been, and still remains, a serious threat in tropical countries. It killed 40,000 of Napoleon's best troops after they won the military battle against l'Ouverture in Santo Domingo in 1802-1803. It killed a reported 100,000 Spanish soldiers during the colonial wars with Cuba, which prompted the noted Cuban public health expert Pedro Nogueira in 1956 to call it, ruefully, "the best ally of my country.» Since 1949, the original publication date of Bring Out Your Dead, outbreaks have occurred in Ethiopia in 1960-1962, causing an estimated 15,000-30,000 deaths, and in western Nigeria in 1987, with 805 cases and 416 deaths reported. The actual number of deaths in the Nigerian epidemic may have been far higher, perhaps in the tens of thousands, as projected by health surveys in the affected areas. The virus finds a large natural reservoir in monkeys in tropical rain forests, and there is no hope of eradicating it. Even now the disease is often lethal, with death rates as high as 50 percent in epidemics among nonindigenous groups. An effective vaccine is available, but is not produced in the United States. Perhaps another yellow fever epidemic might yet strike in the United States. The mosquito that transmits the fever, Aedes aegypti, is abundant in urban areas in southeastern United States, and another potential vector, the mosquito Aedes albotictus, has recently appeared. If the virus were reintroduced, many deaths might occur before health authorities could marshal enough vaccine to protect the population. In 1992 the U.S. Institute of Medicine estimated that an outbreak of yellow fever in a major American city such as New Orleans might result in as many as 100,000 cases of the disease and 10,000 deaths. Such disasters can only be prevented by promptly diagnosing new cases and taking prompt and effective anti-mosquito measures. Many other known and presently unknown microorganisms might emerge to become major public health threats as well. The present AIDS epidemic arose when an obscure virus, human

Introduction

xv

immunodeficiency virus (HIV), somehow moved into the human population from monkeys in Mrica. The Institute of Medicine report urged that better methods be adopted for surveillance of infectious diseases to help stop new epidemics in their earliest stages. Many of Rush's medical colleagues would have firmly agreed. Bring Out Your Dead is the best known work of John Harvey Powell (1914-1971). It garnered enthusiastic reviews when it was first published in 1949. Time-Life Books republished the volume in 1965, and the Arno Press and the New York Times republished it in 1970. While clearly aimed at popular audiences, Bring Out Your Dead was based on Powell's extensive research about the episode. Certainly nobody has gone over the ground as thoroughly as Powell. Its few errors, for example a romanticized account of John Todd's death, are minor and peripheral to the main story. The book continues to speak to us today, and the 44 years since its debut have not diminished its appeal as a fascinating part of our history and a remarkably good read. Powell was raised in Ottumwa, Iowa, where his father was for many years the publisher of the Ottumwa Courier. He graduated from Swarthmore College in 1934, and earned his Ph.D. in American History at the University ofIowa in 1936. Powell taught during the years of World War II at the University of Delaware, and then, in 1945, became director of research at the 52nd Street Branch of the Free Library of Philadelphia. He left that position in 1955 to devote full time to research, writing, and lecturing. Powell moved back to Ottumwa in 1963, where for the last four years of his life he was handicapped by illness. He died on January 1, 1971, at the age of 56. His other books include a biography, Richard Rush, Republican Diplomat, 1780-1859(1942), and a collection ofstories, George Washington and the Jackass (1970). He also left four unpublished historical plays. Many of the scenes described by Powell are preserved at Independence National Historical Park and other historical sites. The

XV!

Introduction

houses occupied by Bishop William White (a neighbor of Rush) and John and Dolley Todd are parts ofIndependence National Historical Park. (John died in the epidemic; Dolley soon remarried J ames Madison and later became the First Lady, Dolley Madison.) Visitors can tour the Deshler-Morris house in nearby Germantown, rented by President Washington for two weeks during the epidemic. Bush Hill no longer stands. Mother Bethel A.M.E. Church, founded after the epidemic by Richard Allen (and where his body lies today), is the oldest continuously operating Mrican American church in the country. St. Thomas' Episcopal Church, where Absalom Jones served as the nation's first black rector, also continues as an active congregation. Stephen Girard's name (somewhat tarnished by later scandals involving his treatment of his mentally ill wife) lives on as founder of Girard Bank (recently absorbed by Mellon Bank) and Girard College (originally a school for "poor white male orphans," only recently opened to all races and sexes). Dock Street, once the site of a notorious drainage ditch in the city, is now the name of a highly regarded local beer. Kenneth R. Foster Mary F. Jenkins Anna Coxe Toogood References

J. Adams. TheAdams-Jefferson Letters. Ed. LesterJ. Cappon. Chapel Hill: University of North Carolina Press, 1959. Vol.lI, p. 346 (letter dated June 30,1813, addressed to Thomas Jefferson). J. Lederberg, R. E. Shope, and S. C. Oaks,Jr., editors. Emerging Inftctions: Microbial Threats to Health in the United States. Washington, DC: National Academy Press, 1992. P. Nogueira. "The Early History of Yellow Fever." In Yellow Fever:A Symposium in Commemoration ofCarlosJuan Finlay. Philadelphia: Jefferson Medical College, 1955. Victor Robinson. "Antroduction" to special issue on Benjamin Rush. Medical Lift 36, 9(1929): 445-496.

Preface to the 1949 Edition Perhaps by writing no man can express What people suffer'd in this great distress! -SAMUEL STEARNS

Do not read this book before eating, or in the midst of a sleepless night. For it is a revolting book, filled with disgusting details of a loathsome disease. And unfortunately, all the details are true. As true, that is, as men's knowledge of the truth ever is. So great was the tragedy, so astounding the scenes of suffering, that one after another of those who lived through the plague wrote down what they saw. They are responsible for all the facts recorded here; and if they sometimes saw things that could not happen, told stories beyond belief, that is because they were men, not cameras. The historian can never construct a record of events. All he can do is construct a record of records. The Yellow Fever in Philadelphia in 1793 is one of the great tragic episodes in the human history of this land. It was the most appalling collective disaster that had ever overtaken an American city. For a century afterwards, the fearful disease remained an annual threat for people in many states and many towns to dread, and every year they remembered the great Philadelphia plague as the worst, the most frightening, the very classic of plagues. The yellow fever is gone now, and the record no longer helps us in preventive medicine. But the human values of those hundred days of horror remain, with all the cowardice and courage, the cynicism and faith, the knowledge and the vanity that people have. This is the story of a foul and fantastic pestilence, striking XVI!

XVlll

Preface

without warning in all classes of society. It is the story of people sick in body and heart, astonished and fearful, paralyzed by the mysterious obscenity about them. Men, said Epictetus, are tormented with the opinions they have of things, not by the things themselves. Yet this is torment, none the less, and leaves scars deeper, uglier, angrier than a saber wound. Philadelphia was a low, level town, hottest and dampest of all the American seacoast, hotter even than Charleston, Savannah, or the West India cities, people said. Wharves jutted out into the river and cut off the current; high tide deposited rotting stuff on the banks and in the mud. Below the city were swamps, marshes, pools in clay pits, stagnant water. Most of the streets were unpaved. There was no water system, and only one sewer, under the serpentine of Dock Street. Elsewhere holes were dug, as at Market and Fourth streets, to receive water from the gutters. These "sinks" exhaled a noxious effluvia, for dead animals and all kinds of nauseous matters were hurled into them to putrify. All the wells were shallow; citizens continually pronounced them polluted. In 1793, Philadelphia had about 55,000 inhabitants. Ordinarily, some 2,500 were born every year, and every year around 1,400 died. Many of the citizens were German-speaking, many French; 2,500 were Negroes. The middle-aged had lived through the American Revolution; even boys in their teens could remember when the treaty of peace had been signed ten years before. The city was America's national capital-temporarily, for Washington on the Potomac was being built; but until 1800 the government was by the Residence Act decreed to remain in Philadelphia. The greatest figures in public affairs gathered here: this plague was an incident in George Washington's life, and John Adams', Thomas Jefferson's and Alexander Hamilton's. It precipitated a quaint constitutional crisis; it also affected politics. John Adams, who liked to make things seem bigger than they were, wrote that only the Yellow Fever of '93 saved the United States from a revolution of government.

Preface

XIX

But the plague was the whole people's problem, not the giants' only. Though the great men weave in and out of the story, the heroes of this book are the little people of Philadelphia, men history usually forgets-the mayor Matthew Clarkson, the tavern keeper Israel Israel, the merchant Caleb Lownes, the music master Andrew Adgate, an umbrella maker, a cooper, a one-legged blacksmith, the warden of the jail. And Stephen Girard, hero of Bush Hill, a man so extraordinarily gifted in courage and charity that Philadelphians never afterwards understood him, but stood in uneasy awe, suspicious that so much goodness should live in a Frenchman and a man of trade. And two Negroes, former slaves, whom white men had insulted in a house of God, but who now were the first to show that fear could be conquered by the spirit of Christian love. And the doctors-those wonderfully learned, disputatious, enquiring, credulous eighteenth-century doctors, who stood between medieval and modern medicine, proud of traditions and systems millenniums old, enchanted by experiences as new as the great new world. For all their abundant observations and good sense, the doctors had but to name a thing to make it real, had but to find a theory to cure the ills from which men died. Today, because of the heroism of Walter Reed and his volunteers, we know that the yellow fever is not contagious, cannot be defeated by fumigation or isolation, has nothing to do with thunder, lightning, or the new moon. Reed discovered that it is carried from one person to another by a female mosquito, known as Aedes aegypti. Aegypti is an especially fierce biter in the early afternoon. If she bites a yellow fever victim in the first three or four days of his fever, the germs of the disease pass from the patient's blood into aegypti's stomach. During the next twelve days, they migrate from her stomach into her salivary glands, from which she discharges them into the next person she bites. After she is infected, aegypti can inject the disease into a different human being every three days, which

xx

Preface

is as often as she feeds, and can go on doing so as long as she lives, which is roughly until frost. She causes a ferocious sickness, usually fatal. It begins with chills and pains in the head, back, and limbs; temperature rises rapidly to a great height, bowels are costive, urine scanty and albuminous. This lasts a few days. Then the fever declines, and sometimes the patient appears to have recovered. But a remission follows, after which temperature rises again, the victim turns yellow, throws up a stale blood, black in color; hemorrhages occur in the intestinal mucous membrane. Last comes a typhoid state, marked by stupor and hebetude, dry brown tongue, rapid feeble pulse, incontinent faeces and urine, rapid wasting. From the external symptoms the disease takes its common names, the Yellow Fever, or the Black Vomit. The patient's appearance is ghastly, the stink of the sickroom overpowering. Now, because we know the carrier, we have erased the yellow fever from temperate zones. Scarcely a doctor practicing in the United States today has ever seen a case, or would know what to do if he saw one. But in 1793 neither doctors nor anyone else knew the significance of the mosquito. Varro, an ancient Roman, had warned farmers not to build their houses on swampy ground, "because certain animals, invisible to the eye, breed there, and, borne by the air, reach inside the body by way of the mouth and nose and cause diseases which are difficult to get rid of." But eighteenth-century scientists had abandoned such notions of tiny monsters in the air, sinister and invisible. Instead, they realized that the air itself was composed of molecular fluids and solids, and somehow, they felt, these became infected. They were good observers, these doctors. They described the disease accurately, with faithful attention to detail. And they all mentioned the large number of mosquitoes, even though they comprehended no connection between the two. They stood, confounded with the fever, as we stand today with polio or cancer. They cannot be condemned. We should regard them,

Preface

XX!

as their leader Dr. Redman regarded his predecessors : "Yea, tho' we may with some reason, from the enlightenment of medical science since, smile at their mode of theorizing . . . let us rather pay all due respect to their memory and give them all the credit we can.... " To one, we can give an abundance of credit. This book, though it deals with a whole city in plague, is necessarily a book about Philadelphia's most amazing citizen, Dr. Benjamin Rush. "The American Sydenham," people called Rush. He was the greatest among great teachers, when Philadelphia was the medical center of the whole country. He was a father of modern psychiatry, leader of a new school of practice, founder of an American tradition. He remains to this day the most imponderable single figure in the history of medicine in the new world. Noone since Rush has gained such mastery over the whole profession. The plague of '93 was Dr. Rush's greatest moment. His accounts of the fever, in lectures and books, spread his fame everywhere books were read. And his private letters in his heroic labors are among the most appealing literary achievements in the language. Indeed, my difficulty has been to place Rush in a proper perspective, for it is all too easy to feel, as he unquestionably felt, that others were misled where he was shown a great light, others indifferent where he was first in devotion. Dr. Rush's radiant charm is seductive. I find I sometimes forget, in the spell of his presence, that he had no common sense. But sense that is common is also dull. And dull, Dr. Rush never was. Mathew Carey helps with the perspective-Carey, the Irishborn publisher, historian of the plague. Some said his successive tracts describing it saved him from bankruptcy. And the writings of all the others-the diarists, the doctors, the citizenshelp, too. Some could even write as though Dr. Rush had never lived. It was a gross error on their part. The French doctorsthe wonderful Deveze, Dr. David Nassy, the elusive M. Robert who suddenly turned up in Philadelphia from the Philippine

XXI1

Preface

Islands-these shrewd, cautious physicians of an alien culture unquestionably saved lives. Rush unquestionably spent them. But a plague is not a matter of science, a calculus of life and death. It is a matter of the soul. Rush felt this. He knew one more thing than the scientists knew (for in the true sense, he was not a scientist)-he knew that truth is no physical thing, but an element in the moral structure of life, unprovable, unseen. Historians are dependent on their sources. Had I more time and ability, I should have made this book a novel, for there are so many things the sources do not tell. There are heroisms unrecorded, great moments of beauty and courage that have left no trace, unknowable human experiences that would teach wisdom and understanding. I wish Matthew Clarkson had told his story, and Caleb Lownes, and Peter Helm. I feel sure Dr. Hodge must have been a man of sturdy heart and fine abilities. And what must Stephen Girard have seen! But history is always full of gaps. And looking back over the sources, I am a little surprised that so much is really here in the record, so many individual people somehow emerging a little more than just a name, a little more than life-size, for a moment at least, in the long stream of things that men have thought, and done, and said, and felt.

Acknowledgments THE staffs of the Free Library and the Library Company of Philadelphia have given invaluable help in the preparation of this book, as have the librarians and staffs of the College of Physicians, the Historical Society of Pennsylvania, the American Philosophical Society, the Connecticut Historical Society, the American Catholic Historical Society, and several other institutions. Henry Adams was most courteous, helpful, and generous. Many friends and many people who heard me talk on this plague furnished special information. lowe particular thanks to Margaret J. Duxbury for patient help with the manuscript. Catherine Drinker Bowen read the manuscript through in its various stages, devoting many days to patient criticism. Lois Given, Charles Lee, and David Appel did likewise, and Lyman H. Butterfield read the sections dealing with Dr. Rush. Richard Harrison Shryock studied the whole book and made numerous suggestions. Venia T. Phillips gave me the benefit of her knowledge of entomology. Harold A. Spilman, M.D., Martha A. Bell, R.N., and Carl Bucher, M.D., were most helpful in medical details. Erwin Clarkson Garrett, Joseph Sickler, Mr. and Mrs. Joseph Carson, Nicholas B. Wainwright, Charles F. Jenkins, Mabel Zahn, J. Bennett Nolan, and many others supplied numerous suggestions and out-of-the-way material. To these, and to others who have been interested and encouraging, I extend sincere thanks.

XXlll

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