The lesson of a city saved by shared sacrifice and civic responsibility is an inspiring one for 2020, when so much hangs upon popular cooperation with calls for social distancing, home sheltering, and public masking. But while Carey’s story ends happily in 1793, that outbreak was only the beginning of a longer ordeal, and one that carried different lessons for the present. Yellow fever returned to North America every summer until 1805, claiming more than 12,000 lives in the process.
At first, Philadelphia’s new Board of Health optimistically hoped for public cooperation: “Individual interest should yield to a temporary sacrifice, in order to avert the public calamity. It is a duty every citizen owes to the community . . . impeding the progress of contagion.” Without citizens helping to keep the city clean, to inspect conditions, and to inform on health code violators, the regulators conceded, their success could only be “partial and limited indeed.”
But unity soon devolved into bitterness and acrimony. Doctors clashed in vain over the cause and cure of the disease, nowhere more furiously than in Philadelphia. The full scope of the fever controversy was complex, but revolved around a central question: Was yellow fever a specific and contagious disease imported from the West Indies, or a generic inflammation produced by local environmental conditions and atmospheric contamination? Even during the first outbreak, poet Philip Freneau satirized the division between climatists and contagionists, juxtaposing “Doctors raving and disputing” with “Death’s pale army still recruiting.” Unfortunately, the doctors’ quarrel was only warming up.
Every year, as the fever returned to claim more victims, the rival schools (quite literally: Climatist Benjamin Rush founded his Academy of Medicine because the largely contagionist College of Physicians rejected his ideas) renewed their fight in the public eye, trading charges of ignorance, superstition, and malpractice. As Freneau had suggested, the argument produced more heat than light, and this vitriol began to wear away at popular faith in medical expertise. Every year after 1794, the Board attempted to enforce stricter and stricter quarantines, but the public pushed back ever more resentfully at these obligations, its ire compounded by the fact that the regulations seemed to powerless to control the epidemics.
These tensions came to a head in the catastrophic outbreak of 1798. Because more people fled the city sooner, the summer ended with a lower death toll than the 1793 outbreak, but it had a higher mortality rate among the poor residents who could not afford to leave, taking some 3,500 lives. The Board found itself deadlocked at every turn by internal discord. And the public was losing patience with the failure of both climatists and contagionists to deliver a single tangible success in the fight against yellow fever. Quarantine evasion and other measures of resistance reached their peak.