American History Tellers - Yellow Fever Epidemic of 1793 | The Great Debate | 4

Episode Date: November 30, 2022

The yellow fever epidemic of 1793 posed one of the greatest threats to the young United States. Doctors and scientists couldn’t agree on the cause or the treatment. They split into factions and debated their theories publicly. On today’s show, Thomas Apel, historian and author of Feverish Bodies, Enlightened Minds: Science and the Yellow Fever Controversy in the Early American Republic, joins host Lindsay Graham to discuss how science, religion and politics were intertwined in the controversy surrounding the epidemic.Listen ad free with Wondery+. Join Wondery+ for exclusives, binges, early access, and ad free listening. Available in the Wondery App. https://wondery.app.link/historytellersSupport us by supporting our sponsors!See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Wondery Plus subscribers can binge new seasons of American History Tellers early and ad-free right now. Join Wondery Plus in the Wondery app or on Apple Podcasts. Imagine it's July 1795. You're the health inspector for the Port of New York, and you're standing on the main deck of a merchant brig, the Zephyr, docked at South Street Seaport. The ship arrived late last night from Saint-Domingue, and you're here to examine its crew to determine whether any of them are carrying contagious diseases that might endanger the city. Zephyr's grizzled captain stands beside you as you gaze down at a young and sweaty

assistant engineer slumped over on a wooden stool. Well, this is the last of them, Doc. You hold a hand to the engineer's forehead. Oh, you're burning up. Any headaches? The man nods as you press two fingers to his wrist, and your heart rate feels slow. You need rest, and lots of it. Captain pats the engineer's shoulder. It's nothing that an extra dram or rum won't fix. You'll be fine in no time, won't you? The engineer smiles weakly. I'm sure he will be, Captain. But what's this I hear about a death you had on board? The captain scratches his beard. Junior deckhand, just this morning. May I see the body? Captain sighs heavily. If you must,

follow me. You follow the captain down into the hold of the ship. He points to a large burlap sack next to a stack of crates. The poor boy wasn't even 13. How long was he sick? Just a few days. You swat flies as you crouch down to untie the sack. You peer inside and wince from the odor of the small, decaying body. You lift an eyelid, and the deckhand's eye has a yellow tinge. He's jaundiced. Looks to me like yellow fever. I suspect several members of your crew have it too. Yellow fever? Absolutely not.

The boy had nothing but a bad case of worms. You retie the sack. No, I've seen enough. Thank you for your time, Captain. We'll make sure this boy gets a proper burial, and you can expect a copy of my report tomorrow. Well, the sooner the better. We need to unload our cargo. I'm already a day late on the delivery. Well, unfortunately, Captain, you won't be unloading anything. I'm recommending a quarantine. A quarantine? Oh, that's not necessary. Yellow fever is spreading throughout your ship.

We can't risk it entering the city. No, no, I won't stand for this. I've got orders to fulfill. The captain scowls at you, but you won't be cowed. A quarantine it is, and good day, Captain. Like I said, expect the official report tomorrow. You walk back up the stairs into the bright light of day, shaken to see yellow fever claim another victim, especially one so young. But you take comfort in knowing that you can stop the disease here on the ship before it has any chance to ravage your city. Kill List is a true story of how I ended up in a race against time to warn those who lives were in

danger follow kill list wherever you get your podcasts you can listen to kill list and more exhibit c true crime shows like morbid early and ad free right now by joining wandry plus from wandering comes a new series about a lawyer who broke all the rules. Need to launder some money? Broker a deal with a drug cartel? Take out a witness? Paul can do it. I'm your host, Brandon James Jenkins. Follow Criminal Attorney on the Wondery app, or wherever you get your podcasts. From Wondery, I'm Lindsey Graham, and this is American History Tellers, our history, your story. In July 1795, New York Harbor Health Inspector Dr. Malachi Treat bordered the Zephyr, a merchant ship from the Caribbean. In the two years since a deadly yellow fever epidemic hit Philadelphia, New York City had begun to inspect incoming vessels that might spread illness.

Inspector Treat examined several sick crew members and the corpse of a young boy. He suspected yellow fever was to blame and wrote a report to the city health committee recommending that the Zephyr be quarantined. But the health committee sided with the captain, who challenged Treat's diagnosis. The captain was allowed to land his crew and unload his cargo. But Treat had been right, and soon yellow fever spread throughout New York. Ten days after inspecting the Zephyr, Treat himself died from the deadly disease. As cases climbed, city officials suppressed the truth

in hopes of protecting New York's commerce and reputation. Hundreds more died that fall, and it was determined that that was just the cost of prioritizing profit over public safety. Throughout the 1790s, yellow fever returned again and again to cities across the northeastern United States. My guest today has spent years studying these epidemics and their impact on science, society, and intellectual thought in our young nation. Thomas Appel is a teacher, historian, and author of the book Feverish Bodies, Enlightened Minds, Science and the Yellow Fever Controversy in the Early American Republic. Here's our conversation. Dr. Thomas Appel, welcome to American History Tellers. Thanks for having me. So the 1793 yellow fever epidemic in Philadelphia is not a widely

known event. When did it get your attention and what led you to pursue it for further research? Well, I first came upon it as an undergraduate. I was doing an honors thesis at the end of my degree and was interested in disease, found that this disease had occurred in Philadelphia in this really dramatic way. And I had a lot of questions about what folks were talking about and a lot of ideas about the body and about disease and how it moves around that I just didn't understand. And it appeared to me to be very sort of arcane and

abstract. And it was the desire to answer those questions that sort of led me down the path of studying yellow fever. Well, let's talk about the conditions in 1793 Philadelphia that made it ripe for an epidemic. What was going on at that time and at that place that made this possible? The short answer is that Philadelphia had extensive commercial connections with the Caribbean, and in particular with Saint-Domingue, the French colony in the Caribbean. It's a big sugar-producing colony. And it was also the site of a war. There was the beginning of the Haitian Revolution, which started in 1791 with a slave revolt.

And the French sent armies over to Saint-Domingue in order to put down the revolt and restore order. And as they did that, they were introducing these huge numbers of non-immune French soldiers, which sparked yellow fever first in Saint-Domingue, and then merchants and refugees, quite a few refugees fled to the United States, were able to carry both the yellow fever virus and the vector of the virus, the mosquito called Aedes aegypti, which transmits it from person to person. That's the short answer. It so happened that Philadelphia, it was an El Nino year in 1793. And so there was an unusual amount of rainfall. And this meant that you had lots of containers containing water where Aedes aegypti mosquitoes could breed,

and lots of people bringing the virus into Philadelphia. And so you have all of the ingredients for an epidemic. So at this point in time, though, both the notion of virus and mosquito vectors for disease are just completely unknown. In 2016, your book about the epidemic, Feverish Bodies and Enlightened Minds, in it, you refer to the people studying the epidemic at the time as investigators. Today, we would look to doctors or epidemiologists. But what would we think of these investigators today? Do they resemble our current disease specialists? Many of them were doctors and they were trained in medical schools and underwent some kind of apprenticeship and you know they were part of a well-established

profession so there's some consistency in the medical field. With scientists it's a little bit different just the term scientist wasn't even coined until middle of the 19th century. People did science. They investigated nature and they did it in roughly similar ways to today. So, you know, empirical, inductive, experimental approaches. But there weren't very many professional opportunities available to people who did science. Another difference is the nature of authority in the 18th century. So when COVID-19 struck, for example, doctors and scientists offered their guidance to the public, and they did so from within these, you know, well-established, authoritative professional institutions, the CDC or the World Health

Organization, so on. And they tended to speak for the community of medical and scientific experts as a whole. When they offered guidance about what to do about COVID-19 to the public, they had already decided among themselves what the answer was, and they were giving it to the public. In the 18th century, these investigators came at it as individuals. And when they offered their guidance, they were doing so as individuals. And they were openly contesting the key points out in the public. So rather than sort of having your medical and scientific profession decide answers and give it to the public, 18th century investigators were sort of trying it, contesting it right out there in the public sphere. It was going to be decided through a public debate.

So this exploration of the disease and its causes in public obviously sorted itself into some sort of factionalism, different schools of thoughts opposed to each other right in the public eye. But I was interested to know that these factions were not just medical opinion, but political opinion. How did these two sides roughly assemble? So there are two schools of thought about yellow fever. And generally speaking, there's a whole range of diseases that generate a debate that funnels into this kind of two-party kind of system. So you had a school of thought, contagionism. Those who supported this would be contagionists.

And they said that, well, you know, yellow fever is clearly transmitted from person to person. In Philadelphia, there was no yellow fever. Then all of a sudden you get these incoming vessels and they have yellow fever patients on them. And shortly thereafter, there's yellow fever patients on them and shortly thereafter there's yellow fever in Philadelphia. So, you know, there's clearly a connection here. This disease must be contagious. It moves from person to person. The other school of thought, localism or miasmatism, held that there was some kind of local condition that caused the disease. Putrefying matter, excrement, some kind of foul air that hovers

around dirty, unclean cities generates disease in certain conditions. And they would say, look, yellow fever, it only occurs in cities. It doesn't occur outside of cities. So clearly, you know, there must be something about the city itself that generates yellow fever. It tended to be in the early American Republic that localists favored the Republican Jeffersonian kind of vision for the United States and the contagionists favored the Hamiltonian federalism. And there was self-interest at work, for sure. Part of the Federalist program was to protect domestic manufacturing. They wanted to build a big manufacturing economy. And in order to do that, they needed to have these kind of urban centers that were centers of manufacturing. So contagionism

sort of benefited them because quarantine would prevent the import of manufactured goods and thus protect the local production. And it exonerated cities from charges of being unhealthy. There had to be cities in the federalist vision in order for the economic growth that they wanted. Localism dovetailed with republicanism, the Jeffersonian creed, which saw the United States as being an agrarian economy made up of small farmers. Cities didn't have a prominent place in Jefferson's view of the United States. So localism sort of flattered that view of the political and social future of the United States because it confirmed that cities were indeed dreadful places of vice and unhealthiness. But in fact, in the case of yellow fever, both of these schools of thought are both

kind of wrong and correct at the same time. Yellow fever is not directly contagious person to person, but is contagious if local conditions are right. Yeah, that's right. The contagionists had a good point that, yeah, the yellow fever didn't occur until someone arrived with yellow fever in the port. So there was a connection there. And the localists were also partly right that local conditions favored the occurrence of yellow fever because Aedes aegypti mosquitoes did find a home in Philadelphia. It's kind of a finicky little creature. It actually will prefer to breed in the artificial containers of water that humans keep around them. So it tends to occur in urban areas, not outside of urban areas. So the localists were right to say that, you know, there was something kind of special about the environment of a city that led to yellow fever. And that's what I think makes the debate so interesting is that they both have fairly good points. And I think in scientific debates, when both sides are sort of evenly matched, it incentivizes creativity. And so for the historian's point of view, you have these people exploring kind of arguments and articulating assumptions that they usually do not. Now, did these two factions have different approaches to treating yellow fear?

The treatments don't align perfectly with the causal theories. So, you know, there's a range of treatments. Benjamin Rush, one of the better known doctors of the period, had this heroic treatment where he thought that a kind of drastic intervention in the patient would cure them of yellow fever. And so he practiced these dramatic blood lettings on his patients. And then there was a French cure, which involved administering quinine, the anti-malarial, and subjecting the patient to cold baths. The correlation between the methods of cure and the cause of the disease and the politics behind it don't align perfectly. And just so our listeners are clear today, what is the modern treatment for yellow fever? Well, there isn't a cure by any stretch.

Antivirals can help if they're administered early enough, but really it's close nursing attention. There isn't a cure. The best cure is there's a vaccine for yellow fever. So just a prophylactic is by far the best way of avoiding yellow fever altogether. Are you in trouble with the law? Need a lawyer who will fight like hell to keep you out of jail? We defend and we fight

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so don't miss it. That's 33% off everything, plus free shipping at TommyJohn.com slash A-H-T. See site for details. At this moment in American history, and in fact, European history, most political thinkers are enraptured with the Enlightenment. A large portion of that is an appeal to reason, celebrating common sense. What was the common sense approach to science and investigation at this moment, and how did it apply to discovering treatments and cause for the fever? So, common sense is this idea that came out of Scottish philosophy in the 18th century. And it was used in a couple of different senses. One of them was grounded in a kind of religious idea even that something would be common sense if it seemed to fit plausibly into the

design of God's world. So an example, there's this medical and scientific journal in the 1790s, the first medical and scientific journal in the United States called the Medical Repository. And there was this exchange in there about vegetarianism. And the participants were sort of weighing the virtues of vegetarianism. And one of them said, well, you know, if you look at the teeth of humans, there's these incisors that are clearly there for tearing flesh, for eating meat. And so if a human being has these meat-eating teeth, and if God created human beings, then it seems as though God wanted human beings to eat meat, right? So that's an example of the way that a common-sense argument would work. It was very much based in religion and it was sort of synonymous with arguments based on design.

And how did this common sense approach apply to investigating yellow fever in particular? Well, localists used it. They argued that locally generated yellow fever was more plausibly a element of God's creation because people could do something about it. You know, it stood up to this kind of religious test that the Bible says don't allow filth to accumulate. There's fairly elaborate cleanliness rules and laws laid out in the Old Testament, and the violation of those laws is the generation of locally caused disease like yellow fever. So it seemed like this would be something that God would create. On the other hand, the localists would argue,

a contagious yellow fever doesn't seem like a type of disease that God would create because a contagious disease will just flit about from here to there with no rhyme or reason. It might very well affect people who didn't deserve it, who didn't do anything. So from their common sense rationalizations, they deemed that the local theory, that localism just made more sense as something that God would create. Now, you've also written that this common sense approach might have also provoked intolerance. How would that be the case? Yeah, I think that when you're convinced that your opinion

is not only founded in fact and experience, but that it is the will of the all-powerful creator, it makes any opposition to that opinion not only sort of philosophically wrong, but possibly heretical, dangerously wayward. And so, I think that hardened opinions around the localist theory. Their opponents weren't just philosophically, scientifically wrong, they were morally, religiously wayward. So during the epidemic, there was a rigorous public health campaign to clean the city. But it, as you mentioned, wasn't motivated so much by science, but as a religious onus. I wonder how city officials were able to frame this cleaning not as an effort to rid the city of disease vectors, but a religious duty. Yeah, it was a scientific and religious campaign to clean the cities. Because in a lot of these people's minds, there wasn't a clear-cut difference between science and religion.

Science was the study of God's creation. Nature was God's machine. And so studying it was revealing something about God. And in the common sense way, using a common sense approach to science, one could sort of work the other way too and say, well, what would God likely do might inform the way that nature actually is. So for the localists, cleaning the cities was going to get rid of the sources that generated yellow fever, but it also was going to absolve the sin that had allowed that cleanliness to be there in the first place, which was the denial of these clear-cut laws against cleanliness. That cleanliness is next to godliness, that you must take care of your house and not allow dirty materials to accumulate. So the campaign to end the cities very neatly combined

scientific and religious ideas. And it wasn't just moral or religious intolerance. The influence was political as well. One example was in the field of chemistry, where the findings of a Frenchman, Lavoisier, were rejected because of his Frenchness, and the colonies at the time were not in favor of the French. Can you explain further? Yeah, Antoine Lavoisier, kind of really the most significant pioneer of science in the 18th century. He crafted the oxygen theory of combustion and respiration. He and his clique of chemists in Paris created the nomenclature of chemistry. So oxygen, hydrogen, these terms all derive from Lavoisier and his group of followers. And Americans were initially very enthusiastic about Lavoisier in

the 1780s and even into the early 1790s. But their opinions soured really in a direct correlation to their opinions about the French Revolution, which again, they were all for in the early stages. But then the French Revolution became more radical. And by the end of the 1790s, the dictatorship of Bonaparte was emerging. And so Americans looked at this all and said, what had happened? What happened here with this revolution? Clearly, the French went way too far. And it's generated an aversion to all things French, including French scientific ideas. American chemists and a broad range of thinkers, they sort of cherry pick from the Voissier's theories what they like and leave what they don't. So they're generally enthusiastic about his discussions of chemical reactions,

but they're not a fan of his very meticulous, rigid, experimental approach, which demanded that the chemists measure everything and conduct themselves with this kind of thoroughgoing empiricism. So what they end up doing is sort of leaving that part of it out and using his theories to, in a very common-sensed way, to make these kind of broad rationalizations about what sort of chemical reactions might cause yellow fever to occur. It's probably no surprise that in a moment of crisis like this, given some uncertainty about the cause or solution to the problem, that political, religious, moral, philosophical, ideological factionalism appears in what should be an objective search

for truth. It should also not be surprising that conspiracies spring up, and it was the case here in the 1793 epidemic. What were some of these conspiracies? Yeah, the conspiracies were sort of broad accusations that the other side was engaging in a concerted effort to subvert the truth, to hide evidence, to hide something about the truth of yellow fever, in the interest of getting their view recognized as the correct one. In the Pacific Ocean, halfway between Peru and New Zealand, lies a tiny volcanic island. It's a little-known British territory called Pitcairn, and it harboured a deep, dark scandal.

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which was at Philadelphia at the time, would need to be moved. And so you could see a lot of the debates about where this capital was going to be and would it be in the north or in the south or in some kind of, you know, neutral middle zone being connected to yellow fever. I think that the commercial reputation of Philadelphia began to decline and subsequent occurrences of yellow fever would confirm this. Philadelphia is the biggest city in the United States at the time, and it would be eclipsed shortly after by New York, which would become the commercial center. You do get a lot of factionalism within the medical and scientific world of Philadelphia, which again was the cultural intellectual center of the United States as well. Talking about the differences between doctors and scientists in the 18th century and today and medical and scientific

fields are much more institutionalized and professionalized, and scientists and doctors don't necessarily want to hash out the debates in the public. Yellow fever contributed to this. The participants in the debates, a lot of the students who came of age during those debates who said, you know what, we should remove science and medicine from the public sphere and create institutions where we can do this kind of work ourselves and work out these issues ourselves rather than going to blows in the public's eye. The reputation of our fields as a whole need to be safeguarded within institutions. So I argue that yellow fever accelerated the professionalization and the institutionalization of medical and scientific research. Were there any other ways that we can

point to this epidemic as directly impacting our modern system of medicine? I think there's parallels between the 1790s epidemics and modern epidemics, the next big movement in American medicine really starts after 1815 with the end of the Napoleonic Wars. And in a little twist, it would have American medical students going to Paris to study the type of medicine that was pioneered actually during the revolutionary times, which was based on anatomy. It was based on studying the body and just actually being in contact with the body, getting to know tissues and organs. So there's an anatomical kind of revolution in the early 19th century, which does modernize medicine. And I think that American medical students, those who are going across

the Atlantic to study in the Paris Clinic, I think they were doing this at least partially because of how unstable the theoretical bases of medicine were during the yellow fever years. The endless debates about yellow fever cause and cure created discontent among medical people and fueled the search for a firmer empirical scientific grounding for the medical profession. Now you mentioned the parallels between that epidemic and modern ones. Let's investigate some of them. COVID-19 has some distinct disparities in who it affected most. Was that the case in 1793? in subsequent epidemics for a few reasons. The major one is that they couldn't leave the city. In August, September of 1793, Philadelphians left the city, all those who could in a mass exodus. And those who remained were the people who couldn't afford it, who couldn't leave,

didn't have a place to go. And so that left them in the domain of Eidos Egypti. The poor also tended to live close to the waterfront. This is one of these features of these early American cities is that you had the kind of the poorer quarters of the city close to the waterfront. And that meant that they were going to be within the biting range of Eidos Egypti, more than the wealthier people who might live kind of on the outskirts. Add to that that medicine costs money. You know, having a doctor attend to you costs something. And so the poor couldn't necessarily avail themselves of that. Although in some cases, with Benjamin Rush, that might have actually been a benefit for them.

Now, you note that a printer at the time, Matthew Carey, wrote an account of the epidemic in which he estimated seven-eighths of those who died were poor. But his reasoning for that was not that they lived by the waterfront or couldn't afford treatment. It was something a bit darker. Right. He accused the poor of being dirty and slovenly and lazy, which were common accusations in the 18th century. In the 21st century, too, there's unkind notions about those who are struggling. He attributed to that, that their suffering from this physical ailment was a reflection of their moral degeneracy. Alongside the poor, we also know that the Free African Society

accepted a call to have its members treat the sick. Many were volunteers, but they were accused of theft and profiteering. In response, they published their own account of the epidemic. What did that contain? It contained a defense of the black community's heroic effort to service the poor and to serve as nurses at the makeshift hospital and to do a lot of really dirty jobs like moving bodies from houses and delivering them to the communal graveyards. So that was the chief aim of the publication, was to exonerate the community from these charges that they had used their positions to steal. And in doing so, they end up pointing to, I think, what are some of the real reasons behind the disparities in mortality with the disease,

that the poor were being affected so much more severely, is they write that they were assisting mainly poor Philadelphians. And so as you read it, you can kind of get a sense like, oh, the only people left in the city are the people who don't necessarily have the means that others did. So I suppose disparities in availability of treatment or effect of the disease on the poor is one similarity. We discussed political factionalism and ideological splits relating to the science of the disease. That's another similarity we've seen. But what might be some differences between that epidemic and modern ones? We're lucky to have unanimity

from the medical and scientific field. This doesn't mean that everyone listens to it. Obviously, we know that many have openly flouted the recommendations of the medical and scientific community. But we're lucky to have that. You know, we weren't, with COVID-19, there wasn't a faction from within the medical world that said, you know, no, it's not caused by a virus at all. It's, you know, it's caused by a miasma that's caused by the ill-omened alignment of planets or something like that, right?

That's a difference, is having that community speaking with something like unanimity. On the other hand, localism and contagionism were both ideas that were founded on evidence. We could critique the selectiveness with which both sides chose their evidence and what they took in and what they didn't, but they were defending theories that were based on scientific thought. And they were doing it, I think, in their own ways, in a well-meaning way. In our own time, one political faction has openly attacked scientific knowledge and vilified its creators. And that's something that, you know, a difference that doesn't reflect as well upon us with all of our medical marvels at our disposal. So thinking back, we've discussed obvious and not-so-obvious similarities

between these two epidemics and how the people of then resemble the people of today and they're bringing their biases to what hopefully should be an objective search for scientific fact. So I wonder then, what do you think might be our biggest lessons from the yellow fever epidemic of 1793 that are still relevant today? I think it's about preparation. The medical community in Philadelphia in 1793 pre-epidemic was full of confidence and certainty that the revolutionary era was going to usher in this golden age for humankind.

And they were sort of blind to that threat that was right there. They were buying huge amounts of sugar from a slave colony that periodically had yellow fever. And they continued to do this during the early stages of the Haitian revolution. And I think you could say that they weren't aware to the threat that existed. I think it's certainly true with COVID-19 that there was ample warning that, you know, there were several highly infectious respiratory viruses in the last couple of decades that had nearly ignited global pandemics. And yet still, we didn't heed the writing on the wall and do what I think health experts were suggesting that we should do,

to have an extensive plan ready for the likelihood, the eventuality. And so COVID, just as yellow fever did, COVID sort of caught us with our pants down. So I'd say that this, the yellow fever and subsequent epidemics as well should be there to remind us that these things can happen and that we ought not to become so self-confident in our system that we convince ourselves that it can't. Dr. Thomas Appel, thank you so much for joining me today on American History Tellers. Thank you for having me. It was a pleasure. That was my conversation with Dr. Thomas Appel. His book, Feverish Bodies, Enlightened Minds, Science and the Yellow Fever Controversy in the Early American Republic, is available now from Stanford University Press. From Wondery, this is the fourth and final episode of the yellow fever epidemic of 1793 from American History Tellers.

In our next season, four U.S. presidents have been assassinated while in office, and many other assassination attempts have failed. We'll look at three of those deaths, and a near miss, to see what motivated these murderous plots and how they changed the course of our nation's history. If you like American History Tellers, you can binge all episodes early and ad-free right now by joining Wondery Plus in the Wondery app or on Apple Podcasts. Prime members can listen ad-free on Amazon Music. And before you go, tell us about yourself by filling out a short survey at wondery.com slash survey. American History Tellers is hosted, edited, and produced by me, Lindsey Graham, for Airship. at wondery.com slash survey. In a quiet suburb, a community is shattered by the death of a beloved wife and mother.

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