The Pamphlet War

THE epidemic ended in November 1793. The controversy was just beginning. Within months, the major physicians on both sides had gone to press, and the pamphlet war that followed would last nearly a decade, producing more medical literature on a single American epidemic than had ever been generated before. The collection holds the complete record of both sides.

Rush published first and most comprehensively. His Account of the Bilious Remitting Yellow Fever, published in early 1794 as the third volume of his Medical Inquiries, was the definitive statement of the localist, non-contagionist, depletion position: yellow fever arose from domestic miasmatic conditions (specifically the rotting coffee on Ball's Wharf); it was not contagious person-to-person; it required aggressive depletion to treat. Rush laid out the argument with the systematic confidence of a man who had treated hundreds of cases from inside the epidemic and emerged, if barely, convinced that his method had been vindicated.

William Currie published against Rush almost simultaneously. Where Rush was systematic, Currie was combative: the Synochus Icteroides treatise names Rush's methods directly, proposes bark and wine as the superior treatment, and argues that the epidemic was imported and contagious — three positions, each the opposite of Rush's. Currie was one of the founders of the College of Physicians and among the most technically accomplished physicians in Philadelphia. He has received almost no biographical attention in subsequent scholarship, a lacuna that reflects how completely Rush's narrative of the epidemic has dominated the historical memory of 1793.

Isaac Cathrall — a Philadelphia physician who conducted experiments that should have convinced him yellow fever was not contagious, then concluded it was — represents the most poignant dead end in the collection. He injected himself with black vomit from yellow fever victims. He rubbed it into incisions in his own skin. He survived, concluding correctly that the specific matter was "an inert secretion" with no morbific power. Then he maintained that yellow fever was contagious through contact. Both conclusions — right and wrong — came from the same experiments, because the right question (how, exactly, does this disease move between people?) had not yet been formulated. The answer was mosquitoes, a fact that would not be established until 1900.

Rush's most radical act during the pamphlet war was not a pamphlet at all. It was an almanac entry. In 1795, he published his treatment directions for yellow fever — the specific instructions for bleeding and purging — in Poulson's Town and Country Almanac, read by farmers and tradespeople across the mid-Atlantic region. Laypeople could now bleed their neighbors according to Rush's directions, without medical supervision. His opponents found this appalling. Rush found it democratic.

An English clothier named Henry Wansey arrived in America in 1794, the year after the epidemic, and found a city still processing its catastrophe. His observations — drawn from conversations with Philadelphians still raw from the loss — give us something the physicians' pamphlets cannot: how ordinary people talked about the epidemic to a curious foreigner, and what they remembered about it a year later.

Jackson's Treatise on the Fevers of Jamaica arrived in its first American edition in 1795, published precisely because Philadelphia physicians needed Caribbean precedent for the therapeutic debate. Jackson had been treating tropical fever in Jamaica since the 1770s. His general preference for depletion in tropical fever contexts supported Rush's approach and was cited by Rush's supporters as independent corroboration — evidence from a military physician with decades of Caribbean experience that aggressive treatment was correct for diseases of this kind.