In 1793 in Philadelphia, a “malignant fever” struck with a vengeance, eventually killing approximately 10 percent of the city’s population. The cause was traced back to the extremely rainy spring season of that year, which left numerous puddles of stagnant water on the ground and wherever else it could accumulate, followed by a very hot and dry summer. These conditions offered an ideal breeding opportunity for the Aedes egypti mosquito, the insect vector of yellow fever. “The malignant fever,” as yellow fever was called at that time, had visited Philadelphia numerous times in the previous 100 years, but this time, it was devastating.
A few scattered cases undoubtedly occurred and went undiagnosed during the month of July, and it was not until a cluster of cases appeared at the North Water Street rooming house of Richard Denny in early August that the correct diagnosis began to come into focus. Dr. Benjamin Rush, Philadelphia’s most eminent physician, saw a number of cases that exhibited jaundice and hemorrhagic fever, including the daughter of a colleague (Dr. Hugh Hodge). On August 19, Dr. Rush declared that the “bilious remitting yellow fever” had returned to Philadelphia after nearly 40 years’ absence.¹¹* Most individuals who could afford to flee the city did and headed for nearby rural destinations like Germantown and Grays Ferry, leaving behind the less fortunate to ultimately bear the brunt of the epidemic.
Seeking Housing for the Homeless
As the disease raged through the citizenry, and the death toll mounted, it became clear that a facility was needed to house the homeless ill and those without the resources to be cared for. At first, the amphitheater recently erected by John Bill Ricketts to house his traveling circus was chosen. Seven yellow fever patients were taken off Philadelphia’s streets and given shelter in the temporarily empty amphitheater, but very quickly, two died indoors. A third managed to get to the lawn outside, where he also perished. Because corpse carters were scarce, his body lay unattended for several days—a situation that so enraged the nearby home owners that they threatened to burn down the amphitheater unless a site for homeless yellow fever patients could be found much farther away from their properties.
One of the buildings adjacent to the unoccupied manor house at the Bush Hill estate was chosen (see Figure 1). On August 31, a small delegation arrived at the door of the tenant (possibly the groundskeeper) and his family. Matthew Carey, the Philadelphia journalist and publisher who chronicled the 1793 yellow fever epidemic in four editions of a highly popular pamphlet, summarized this encounter with uncharacteristic understatement: “meeting with some opposition from a tenant who occupied it, they took possession of the mansion house itself, to which, on the same evening, the 31st of August, they sent the four patients who remained at the circus.”²
Bush Hill Estate
Bush Hill was a 140-acre parcel of land that originally was part of the much larger Springettsbury estate belonging to the Penn family. Bush Hill extended east-west from the present-day 12th Street to 19th Street and north-south from Fairmount Avenue to Vine Street. In 1723, the land was given to the Philadelphia lawyer Andrew Hamilton as payment for settling the estate of the deceased William Penn, Hamilton’s friend and client. Hamilton had the Bush Hill manor house built in 1740, but he enjoyed it for only a year before he died in 1741. The property then passed to his eldest son James, who never married. Upon James Hamilton’s death in 1783, his nephew William inherited Bush Hill.
William appears to have been preoccupied with botany and English country estates. He had very little interest in Bush Hill, and there is no record of his ever occupying the manor. He eventually settled into the mansion at The Woodlands, another estate he had inherited (located on the west side of the Schuylkill River) he had built in about 1770 and expanded in the late 1780s. Bush Hill manor was rented to John and Abigail Adams from 1790 to 1791. It was unoccupied when the city of Philadelphia appropriated it for use as a yellow fever hospital in 1793.
Incompetent Staffing at Bush Hill Hospital
Located two miles from the center of Philadelphia near what is now 18th and Spring Garden streets, the hospital was initially staffed by several nurses and four visiting doctors: Philip Physick, Michael Leib, Isaac Cathrall and William Annan. They were compensated 70 shillings per visit by the city. The doctors rarely arrived before 11:00 a.m. Much of their time at the hospital was spent performing autopsies. In the first two weeks after August 31, the four doctors visited the hospital only 12 times in total: five visits by Dr. Physick, three by Dr. Leib and two each by Drs. Cathrall and Annan. When several members of the committee of citizens (“the Committee” formed initially on September 12 to conduct the city’s business in the absence of most members of the city government) inspected the hospital on September 13, they reported the following:
That the Hospital is without order or arrangement, far from being clean, and stands in immediate need of several qualified persons to begin and establish the necessary arrangements. There are five or six female attendants; but none qualified for the proper management of the sick. It is attended by four Physicians, viz: Doctors Cathral, Physick, Annan and Leib—the latter is indisposed, and unable to attend.
That there are immediately wanted,
A person qualified to arrange and manage a Hospital as Steward.
A person qualified to act as barber and bleeder,—and eight nurses.
That it is unnecessary to enumerate all the wants: they are numerous, and call for speedy attention, but the above mentioned require instant attention, which, when supplied, will reduce the number to a few, and render the institution useful and beneficial.³
The description by Matthew Carey, in his popular pamphlet on the yellow fever epidemic in Philadelphia, of the state of the hospital was considerably more dramatic:
The dying and dead were indiscriminately mingled together. The ordure and other evacuations of the sick were allowed to remain in the most offensive state imaginable. Not the smallest appearance of order or regularity existed. It was in fact a great human slaughterhouse, where numerous victims were immolated at the altar of intemperance.4
There is little wonder that in the first few weeks of the epidemic the city’s poor were terrified of being taken to the hospital at Bush Hill. It was regarded as tantamount to a death sentence. The city was in desperate straits in mid-September 1793. Businesses were closed, mail was not delivered, banks were not issuing loans, the local government was barely functioning, and dozens of citizens were dying each day from a disease whose cause was unknown. To add to the psychological impact, George Washington, the President of the newly formed United States, had left Philadelphia on September 10 for his annual visit with his family to Mt. Vernon.
A Shocking Surprise
The near-miracle that happened next is best summarized in the Committee minutes of September 16:
Stephen Girard and Peter Helm, members of this committee, commiserating the calamitous state to which the sick may probably be reduced for want of suitable persons to superintend the Hospital, voluntarily offered their services for that benevolent employment. Resolved, that they be encouraged immediately to enter upon the important duties of their appointment.5
Stephen Girard (see Figure 2) was Philadelphia’s wealthiest citizen. His decision to suspend a good deal of his private business activity in favor of service to the city’s poor and ill was surprising and shocking. He was joined by Peter Helm, a kind, unassuming barrel maker of no notable social or economic stature. Girard was convinced that yellow fever was not contagious. He had no qualms about working in close contact with the hospital’s yellow fever patients, which he did day in and day out. Helm, on the other hand, “expected never again to return to the city alive.”6
The two managers immediately jumped into action, with Girard taking charge of the inside of the hospital and Helm the outside. The 14 rooms and three hallways in the mansion were converted into one matron’s room, two supply rooms, 11 patient rooms and two hallways. A gender-matched nurse was assigned to every patient room. Each patient was provided with a pillow, sheet and blanket, as well as a plate, a bowl and eating utensils. Patients who were clearly dying and those who were very ill were placed in two rooms separate from the more robust patients. By September 17, one day after the two managers began their new jobs, nine female nurses and 10 male nurses had been hired, and the employees deemed unqualified or unfit had been dismissed. Also on September 17, Peter Helm found a spring of water not far from the manor house. Soon, this spring became the source of freshwater for the hospital. Helm immediately established a system of receiving yellow fever patients from the city. They were placed in a box, temporarily lowered into a hole and then transferred to the hospital, presumably in a stepwise decontamination effort.
Creating a Compatible and Efficient Medical Team
Stephen Girard was somewhat scornful of doctors in general, and particularly those who practiced the aggressive bleeding and purging that Benjamin Rush espoused. The four doctors assigned to the hospital at Bush Hill practiced in the Rush tradition. Moreover, their very infrequent visits to the hospital annoyed Girard, who felt that a live-in physician was what the hospital really needed. Between September 16 and September 21, Girard, his hand-picked choice for Physician-in-charge, Dr. Jean Deveze, and the four hospital doctors met at different times with the Committee to propose their versions of the hospital’s medical hierarchy.
The Committee passed was an almost laughable succession of indecisive and contradictory resolutions. The Committee first gave full direction of the hospital to the two managers and then to the four hospital physicians, then divided the medical responsibility between Drs. Deveze and Physick, and finally, created three hospital divisions with Dr. Leib in the third division. At that point, the four original hospital physicians capitulated and left Dr. Deveze in charge.
This result was exactly what Stephen Girard had wanted. Dr. Deveze was a French military physician who had arrived in Philadelphia in early August after barely escaping the slave uprising in Saint Domingue (now Haiti). His medical philosophy aligned nicely with Girard’s. Dr. Deveze believed that yellow fever was not contagious, and he felt that nature should be assisted rather than opposed, directly contradicting Benjamin Rush’s approach. Dr. Deveze’s treatment for patients with fever involved keeping them comfortable, administering quinine and perhaps sweetened wine and creamed rice. If necessary, bleeding of small amounts and gentle catharsis could be employed. Soon after Dr. Deveze was installed as the Physician-in-chief of the hospital, Dr. Benjamin Duffield, an expert in midwifery and a Fellow of the College of Physicians of Philadelphia, applied to serve and was accepted at the hospital. His approach to fever was similar to Dr. Deveze’s. The two doctors made a compatible and efficient medical team. They rounded twice a day, aided by three residents and an apothecary. Dr. Duffield submitted all medical reports to the Committee. In all, the two doctors treated 807 patients.
“The mortality rate at the hospital was approximately 50 percent, with most patients dying within the first two days of admission…”
Stephen Girard and Peter Helm were highly organized and insisted that hospital employees keep a meticulous record of admissions, discharges and final patient outcomes. On most days, approximately 20–30 yellow fever patients arrived at the hospital. Available records show that the hospital held 60 patients on September 19. On September 23, there were 140 patients. The mortality rate at the hospital was approximately 50 percent, with most patients dying within the first two days of admission, a phenomenon likely explained by the advanced stage of disease of most patients at that time.
The first half of October marked the height of the yellow fever epidemic: On October 11, 119 individuals were buried in Philadelphia. As cooler weather arrived, the second half of October saw a significant falloff in cases and in corresponding hospital admissions. On October 31, the hospital hung out a white flag with the words “No More Sick Persons Here.”7 Immediately thereafter, one, then two, then four yellow fever patients were admitted to the hospital, and the managers quietly took down the flag. But by November 14, applications for admission to the hospital had ceased.
The hospital’s reputation improved once Girard and Helm took over as managers. By the end of September, citizens with yellow fever (or sometimes, any fever-related illness) were so desirous of admission to the hospital at Bush Hill that a note from a patient’s treating physician attesting to the diagnosis of yellow fever was eventually required for admission.
Some aspects of the yellow fever period at Bush Hill had a humorous side. Having personally seen thousands of cases of yellow fever, Benjamin Rush noted that convalescence was sometimes accompanied “by a sudden revival of the venereal appetite.”8 Apparently, not all of the moans and groans emanating from outdoor tents set up for the hospital’s convalescents were occasioned by the disease itself.
For rendering professional services, Dr. Deveze was compensated $1,500 (equivalent to approximately $39,000 in 2020); Dr. Duffield received $500 (equivalent to $13,000 in 2020). After all expenses were paid, no funds remained to pay the hospital’s matron, Mary Saville. William Hamilton, the owner of Bush Hill, received $2,000 for the use of his property during the 1793 epidemic and as rent for the ensuing 1.5 years in the event that Philadelphia should experience a similar need during that period. The estate was used as a yellow fever hospital again in 1797.
Changes in Bush Hill Over Time
A number of structural alterations were made to Bush Hill during its use as a hospital. Early on, the barn was converted into a convalescent unit. Toward the end of September, as the number of yellow fever patients rapidly increased, additional space was needed for active cases, nurses and convalescents. Within four days, October 2–6, a new 60- by 18-foot building was erected. Another building was built west of the manor house to serve as a morgue and to accommodate empty coffins.
On October 13, injured French soldiers arrived from Saint Domingue. They were given lodging at the hospital at Bush Hill and an opportunity to recuperate. After the epidemic subsided, the hospital was then leased to the French minister to house additional wounded soldiers and sailors from Saint Domingue. Stephen Girard recommended that Bush Hill be used as a permanent infectious disease hospital. Although Girard did not get his wish, the manor house was fitted to treat cholera patients sporadically during the 1840s.
The house and nearby property served as a tavern and a resort during the earliest part of the 19th century. In 1808, a fire destroyed much of the house but spared many of the walls. The following year, the Bush Hill Iron Works factory was erected in the gardens of the old manor house. In 1820, Macauley’s oil cloth factory was erected at the site of the recently rebuilt manor house. In 1875, all buildings in the immediate vicinity of the original manor house were leveled to make way for real estate development.9 Subsequent occupants of the property at or adjacent to Bush Hill manor included the Baldwin Locomotive Works in the 1890s, the Third Philadelphia Mint erected in 1901 and the Community College of Philadelphia since 1973.
The Major Accomplishment of Bush Hill
The hospital at Bush Hill demonstrates what a small group of ordinary citizens, dedicated to a common cause, can achieve in a crisis. Unburdened by the mountain of regulations that exist today, citizens accomplished in several days what would now take several months at the least. (The fact that one of the leaders was the wealthiest man in the city did not hurt the effort.) The hospital did not cure the malignant fever, but it provided a clean, safe and caring environment for indigent individuals. Thus, the hospital’s presence gave a considerable psychological boost to the city at a time when morale was at its lowest. This may have been Bush Hill’s major accomplishment.
1* Except where otherwise noted, the material for this article was gathered from Bring Out Your Dead (1949) by J. H. Powell.