On one point, however, both sides seemed to agree: poor New Yorkers were more susceptible to the disease. Contagious or not, yellow fever appeared most often in the flophouse waterfront districts catering to sailors, dockworkers, and recent arrivals. Valentine Seaman, a leading New York physician, drew a map of these yellow fever cases—a forerunner of John Snow’s legendary cholera “Ghost Map”—to show the epidemic’s concentrated path. Noting the large number of sickened Irish immigrants, Seaman thought this more than coincidental. Hard drinking and filth had weakened their constitutions, he believed, while their heavy “vegetable diet” had left them vulnerable to the rigors of American life. As further proof, New York officials claimed that only “five or six” native-born merchants and a lone minister—a questionable sort—had died in the epidemic. He was, the Episcopalian Seaman lamented, a Methodist.
The fact that shipborne mosquitoes thrived along the waterfront was not then a matter of concern. The very idea that a tiny vector like the Aedes aegypti could cause such an immense catastrophe was simply beyond scientific understanding. Still, what is striking about the writings of New Yorkers in the summer of 1795 is the constant notice of mosquitoes: swarming, biting, relentless, and inescapable. Valentine Seaman remarked that he had never seen as many people “covered with blisters from their venomous operations.” His good friend, Dr. Elihu Hubbard Smith, recorded these words in his diary: “Thursday, September 6—Passed a restless and perturbed night tormented with mosquitoes and incongruous dreams.”
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In 1793, the New York Common Council had appointed a special health committee “to prevent the infectious Distemper now raging at Philadelphia from being introduced into this city.” As a leading member of that committee, Dr. Elihu Hubbard Smith understood the futility of the charge. One might prepare for the arrival of yellow fever, but there was no way (beyond fleeing the city) to avoid its deadly path. An epidemic was inevitable, if not this year, then the next, or the one after that. A tireless advocate for the poor, Smith had lobbied hard for a pesthouse to isolate and treat the victims. With the committee’s approval, he recruited a man he barely knew to become its resident physician. In truth, there hadn’t been much competition for the post, which combined low pay and long hours with dreadful working conditions. The minutes of the Health Committee meeting for August 24, 1795, read, simply: “Dr. Smith reported that he had procured a Young Gentleman to attend Bel-Vue—Doctor Alexander Anderson.”
The epidemic was then at its peak. Scores were dead, and the harbor was quarantined. New York Hospital had recently opened its doors in lower Manhattan, but its board of directors, wary of catering to the city’s unwashed masses, had refused most yellow fever cases. “In consequence of [this] rejection,” a local editor fumed, “it has happened that men, like calves and other live stock, have been put upon carts [and taken to Bel-Vue] over the stony roughness of the pavement, and under the scorching noon-time sun!—a procedure which flared up indignation, as well as alarm, in the citizens who saw it.”
Alexander Anderson arrived at Bel-Vue “in a state of confusion and perplexity”—his words lifted from a remarkable diary he kept during his brief medical career. The son of a printer, raised in quarters above his father’s Wall Street shop, Anderson showed an early talent for engraving. But his deeply religious parents saw only one path for their son—a life devoted to God through medicine. The surest way to achieve this in eighteenth-century America was to do exactly what an aspiring blacksmith or carpenter might do: find a mentor willing to teach him the craft.
In New York City, a medical apprenticeship lasted four to six years. Anderson’s parents sent fourteen-year-old Alexander to live with Dr. William Smith, a family friend. Much of the day was pure drudgery: feeding the horses, sweeping the office, and collecting overdue bills—the chore Anderson hated most. But the good hours were a clinical bonanza. The boy accompanied Dr. Smith on house calls, mixed his drugs and potions, and assisted with bleeding and tooth pulling while “reading all the medical books within reach.”
At twenty, Anderson applied for a doctor’s license, which required “an examination for the practice of physic.” A committee of three physicians grilled him for an hour at a downtown tavern, where successful applicants were treated to a liquid celebration more taxing than the examination itself. Anderson received a “favorable report” from the committee and a suggestion that he mature a bit before hanging out his shingle.
Anderson chose Bel-Vue instead. The job of resident physician appealed to him because it was temporary, ending when the epidemic had run its course. Unsure of his future, yet determined to do the Lord’s work, Anderson saw Bellevue as the ideal place to begin. “My present employment is much against the grain,” he noted. “A sense of duty and acquiescence in the will of God are the chief motives which detain me here.”
Anderson arrived at Bel-Vue to find six yellow fever patients and a patchwork staff. “[They] consist of Mr. Fisher, the steward and his wife, Old Daddy, the Gardner—an old negro, a black nurse and two white ones,” he wrote that first evening. “I spent the afternoon in putting up medicines and arranging matters.”
Things quickly got worse. Anderson’s diary bears witness to the epidemic’s grisly toll. “We lost three patients today,” reads a typical entry. “I am sometimes tempted to resign my station, but, really, I am afraid that like Jonah, I shall meet a worse fate.” And, “Another patient sent up in shocking condition….Vomiting blood by mouthfuls; he died within two hour’s time.” More striking, though, was Anderson’s tender, almost saintly demeanor in the face of overwhelming hardship and grief. At one point, he fired a nurse for dereliction of duty: “She is addicted to liquor, and our patients suffer neglect from her behavior, which is very rough and ill-suited to soothe the mind of a sick person.” At another, he berated the hearse drivers who “glory in a disregard to Feelings and Delicacy” when carting away the dead. Anderson held everyone accountable, including a cowardly peer. “Dr. Chickering’s timidity surpris’d me,” he wrote. “I could not prevail upon him to attend to two children labouring under the yellow fever.”
The 1795 epidemic ended with the first autumn frosts. “Nearly 750 of [our] inhabitants fell to it,” the Common Council reported. “There were admitted into the Hospital at Bel-Vue 238 patients. And 436 persons were buried at the Public Expense.”
The experience left Anderson exhausted, but thankful to be alive. “I passed three months among yellow fever patients and witnessed above a hundred deaths,” he wrote. “Although I was employed night and day and even assisted in opening four dead bodies, I escaped the infection, but suffered from depression of spirits.”
His work at Bellevue complete, Anderson faced an uncertain future. Torn between his own desires (“I cannot help looking back to my engraving table and thinking it is a fitter station for me”) and those of his mother (“If you give up medicine,” she warned him, “you will have spent your six-year apprenticeship in vain”), he enrolled at Columbia’s prestigious College of Physicians and Surgeons to get an academic degree. Anderson married, became a father, and opened a medical office in his home. His depression also returned. “I soon discovered that the practice was a different thing from the study of physic,” he confessed. “The responsibility appeared too great for the state of my mind.”
Forsaking medicine, Anderson opened a shop that sold children’s books he personally engraved. But the business failed, leading to a nervous breakdown fueled by opium and wine. “I am really desperate for want of money,” he wrote, “and every endeavor to pursue it seems in vain.” In 1798, Anderson reluctantly returned to Bel-Vue as the resident physician. Yellow fever was back in New York City, even deadlier than before.
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The world of the American physician in the late eighteenth century was primitive, to say the least. Edinburgh and London, along with Paris and Leyden, were then the major Western centers of medical training. To study there was an honor reserved for a handful of Americans, mostl
y young men from families of wealth and status who returned home to open lucrative practices in seaboard cities like Boston, Philadelphia, and New York.
British medicine in these years was divided into three categories: physicians, surgeons, and apothecaries. Physicians formed the elite. Centered in London, they defined their status through membership in the Royal College of Physicians, which required a degree from Oxford or Cambridge. The rules were strict, the numbers very small. A true physician used his head, not his hands. He observed the patient, judged the illness, and suggested a remedy. The Royal College frowned upon performing surgery or mixing drugs; such mundane tasks were left to lesser men. The physician advised the top ranks of British society on medical issues, and charged a hefty fee. Assuming the role of gentleman, he dressed the part, wearing academic robes and carrying a gold-tipped cane.
The surgeon played a distinctly inferior role. His was a craft, not a profession, often learned on a naval vessel or a battlefield. He went by different names—bone-setter and barber-surgeon were common—and performed the manual tasks expected of a general practitioner. In the era before anesthesia and antiseptic medicine, there was not much to recommend him—and a great deal to fear. A surgeon might successfully extract tonsils, pull a tooth, lance a boil, or close a wound; he knew the rudiments of bleeding with a lancet and evacuating the bowels. But only a desperate patient would contemplate something more. When it came to amputating a limb or retrieving a musket ball, the procedure was as likely to kill the victim as save him.
The apothecary formed the bottom rung of the hierarchy. He was the tradesman, and the most numerous by far. Under British law, an apothecary could sell the medicines he concocted, but couldn’t charge for the advice he might render. Over time, the lines of separation among these groups inevitably blurred. Surgeons began to mix their own drugs, while apothecaries took on patients of their own. And below them was a growing mass of quacks and healers serving those too poor or isolated to look anywhere else.
American society, by contrast, was more provincial and democratic. It barely recognized medicine as a profession in this era, much less one with different levels of status and expertise. Most physicians had begun their careers as apprentices. But few of them had attended medical classes, and fewer still held a degree. Indeed, the United States could boast but four medical colleges in 1800—Columbia, Dartmouth, Harvard, and the University of Pennsylvania. Of the approximately five hundred men described as “medical practitioners” in eighteenth-century New York City and Long Island, twenty-five held medical degrees from Columbia, eleven from Edinburgh, and ten from other European colleges. The remaining 90 percent came to medicine in a multitude of ways: “apprenticed to Dr. Charlton,” “studied with Dr. Cadwalader,” “tutored by Dr. Wilson,” “Barber, Seven Years War,” “Examiner of Ships for Contagious Diseases,” “Surgeon’s Mate on Privateer,” among them. In terms of intellect and training, Alexander Anderson stood head and shoulders above all but a fraction of his medical peers.
With most doctors located in the larger towns and cities, the average American went through life without ever seeing one. What passed for medical care in these years was performed mainly within the family. Women were expected to deliver babies, provide the nursing, and grow the “botanical remedies” of the day. When a serious illness struck, the typical family leaned on “networks of kin and community,” wrote one historian, with deference afforded to older women “who had a reputation for skill with the sick.”
To most Americans, the idea of paying for medical services seemed preposterous. The essentials, when unavailable within families, could easily be plucked from almanacs and medical tracts like John Wesley’s Primitive Physic, which went through dozens of editions. Wesley urged his readers to use their common sense. “Physicians should be consulted when needed,” the saying went, “but they should be needed very rarely.”
In the 1760s, New York became the first colony to move against the “many ignorant and unskillful persons in physic and surgery” by requiring a formal examination of the candidate, not unlike the one that Alexander Anderson would pass in 1795. But popular fears of “elitism” following the American Revolution led most states to loosen the rules regarding would-be physicians. Even New York abandoned its examination in 1797; all it now required was proof of a successful apprenticeship with a “respectable preceptor,” a term liberally applied.
In truth, doctoring was mostly a part-time occupation in this era, shared with farming, tavern owning, and the ministry. Those in medical practice routinely described themselves as “Barber and Wigmaker,” “Pastor-Physician,” and “Practitioner of Surgery and Physick at the Women’s Shoe Store on Beaver Street.” Legally, one needed a license to practice medicine in New York, but there was little fear of practicing without one. The end result of this egalitarianism was to draw even more quacks into the fold. “The law makes no account of the disastrous consequences of [such] ignorance,” a leading New York doctor complained. “It punishes the larceny while it acquits the homicide.”
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The more educated American physicians had some knowledge of Western medical tradition, from the ancient teachings of Galen and Hippocrates to the modern writings of William Harvey on the circulation of blood. In 1800, that tradition endorsed the so-called doctrine of humors, the idea that sickness arose from an imbalance among the body’s four primary fluids: blood, phlegm, yellow bile, and black bile. The number was crucial to the belief: it matched the four universal elements (earth, air, fire, and water); the four cosmos (earth, sky, sun, and sea); and the four seasons of the year. Good humors meant good health; bad humors brought on disease.
What caused the latter wasn’t clear. Medical opinion mostly blamed poisons in the atmosphere for penetrating the body and contaminating its fluids. Sweating, vomiting, diarrhea—these were the common signs of illness, as the system fought to rid itself of dangerous invaders. A problem with yellow bile made one melancholic; too much phlegm made one phlegmatic. The physician’s job was to restore the system’s delicate equilibrium.
Blood was the primary fluid, the one to be most carefully controlled. Physicians had long been impressed by the body’s ability to shed large quantities of blood with seemingly positive results. Hippocrates, for example, saw menstruation as a means “to purge women of bad humors.” It followed, therefore, that the quantity of blood in the body was an essential measure. Too much of it was a bad thing, causing fevers, inflammation, and pain. “Bloodletting,” wrote a student of the art, “was the single most continuously employed medical technique in human history….Blood was taken from virtually every part of the body; hands, tongue, legs, and anus could be tapped.”
Much of this work in America was done by barber-surgeons, whose red-and-white-striped poles became the telltale ornament of their craft—red for the blood, white for the tourniquet and bandages. Blood was drawn with a lancet, with leeches, or with a heated glass cup attached to the skin. Since there was no accurate way to measure body temperature or blood pressure at this time, the volume to be removed varied widely from one case to the next. It was quite common for the patient to lose consciousness during the ordeal; indeed, fainting was viewed as a positive sign, restoring calm to an overtaxed system.
A careful physician in 1800 would study a patient’s humors much like a modern auto mechanic checks the fluids under the hood. Was the person flushed or constipated or coughing up phlegm? Was the urine clear or colored, thin or frothy? The doctor then set to work, armed with an array of concoctions to purge and cleanse the system. His medicine cabinet likely included laudanum, an addictive, opium-based painkiller used to relax overactive nerves; digitalis, a plant extract for the treatment of heart failure; and cinchona, or Peruvian bark, which worked miracles on some fever diseases, particularly malaria, because of the quinine it contained.
But the most popular weapon, by far, was calomel, or mercury chloride, a devastatingly effective cathartic. Hailed for inducing “volcanic vomiting and explo
sive evacuation of the bowels,” this mineral compound became “a reflex for physicians” of the colonial era, despite causing hair loss, rotting teeth, and streams of foul-smelling drool. Doctors were expected to aggressively confront disease; those who wavered might be cast aside. “[We] must cure quickly,” a physician complained, “or give place to a rival.” Calomel became indispensable, its side effects a sure sign of its potency. If the patient recovered—and most do, whatever the treatment—the doctor got the credit.
Take, for example, an average calendar day of a New York City physician in the late eighteenth century:
Patient One: Bleeding, Bleeding Twice.
Patient Two: A Visit and a Calomel bolus.
Patient Three: Sewing Up Ye Boy’s Lip [and] sundry dressings in the cure of it.
Patient Four: Rising in the night, a visit and dose of calomel ye child.
Patient Five: Mercurous wash, Calomel.
Patient Six: Purge for Child, Bleeding and Puke.
Patient Seven: Drawing a tooth.
Patient Eight: Draining a tooth.
The final treatment of George Washington in 1799 provides a more extreme example—the facts provided by his personal physicians. Suffering from a severe throat infection, the former president, then sixty-seven, “procured a bleeder in the neighbourhood, who took from his arm, in the night, twelve or fourteen ounces of blood.” Feeling no better, Washington sent for his doctors. The first to arrive placed leeches in his throat, prescribed an enema, and then “two copious bleedings.” Seeing no improvement, a second doctor ordered “ten grains of calomel…succeeded by repeated doses of emetic tartar,” causing a massive discharge “from the bowels.” Then the real bleeding began. Thirty-two ounces were drawn by lancet, while blisters were applied “to the extremities.” (A person giving eight ounces of blood today must wait two months before donating again.) Washington finally told the doctors to stop. “Let me go quietly,” he pleaded, and he did.
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