Celebrating Independence Day: Fortitude in Philadelphia, 1776

Guest post by Susan L. Speaker, PhD, Elizabeth A. Mullen, and Erika Mills, History of Medicine Division, Library Operations, National Library of Medicine, National Institutes of Health.

Stories of the momentous political events of the American revolution can often leave out the broader context in which they happened, and the concurrent day-to-day challenges Americans faced, particularly to their health. In honor of this year’s Independence Day celebrations, let’s pull back the curtain and peer into Philadelphia in 1776.

In the spring and summer of 1776, the Second Continental Congress gathered in Philadelphia to debate declaring independence from King George III and the British Parliament. Accounts from that time clearly convey the delegates’ fears about the possible consequences of fighting for independence: the American army, vastly outnumbered by British forces, could lose the war; their leaders could be executed as traitors; supporters could have their property confiscated; and the occupying British army could wreak havoc on towns and cities. But British rule wasn’t the only threat to life and liberty during this time. Disease posed yet another significant threat.

A portrait of Dr. Benjamin Rush
Dr. Benjamin Rush, a prominent Philadelphia physician and signer of the Declaration of Independence, split from many of his medical peers over the suspected origins and best treatment of yellow fever. In his book, An Account of the Bilious Remitting Yellow Fever, as It Appeared in the City of Philadelphia, in the Year 1793, Rush chronicled his approach to the disease and experience treating yellow fever patients.

The Continental Congress included many well-educated delegates, and Philadelphia itself (then America’s largest city with about 30,000 residents) was a center for science, commerce, and medicine. Philadelphia was home to America’s first medical college (at the University of Pennsylvania, 1765), first general hospital (Pennsylvania Hospital, 1752), and the American Philosophical Society (1743). Five of the Declaration signers were physicians, including Benjamin Rush. While medical, scientific, and public health knowledge was steadily advancing in the late eighteenth century, it was often inadequate when illness struck. Most of our modern understanding of the physiological, biochemical, and microbial causes of disease wouldn’t develop for another century.

Philadelphia, like most cities of the era, was crowded, and by current standards, filthy.  Sewage and other waste flowed in open gutters and ditches; animal manure was everywhere. Washing and drinking water often came from the rivers. Diseases such as typhoid and dysentery were common as was malaria (transmitted by mosquitoes breeding in standing water). Occasionally, yellow fever (another mosquito-borne disease) invaded the city, taking a terrible toll. When such epidemics arrived, the well-to-do often left town, while poorer folk, including slaves and servants, stayed, caring for the ill, burying the dead, and risking their own health.

A letter written by Dr. Rush to his sister.
In this letter to his sister, written during the yellow fever epidemic, Dr. Rush described the “deep and universal distress” in Philadelphia. He mentioned “190 fresh graves” in the churchyard and “nearly deserted” streets.

The health of the Continental Army, led by George Washington, was also a constant worry. Army camps were much like small cities where crowding and poor sanitation provided ideal conditions for disease transmission. The lack of proper food and shelter made soldiers more susceptible to illness. Many military leaders knew, even before disease microbes were discovered, that cleanliness, proper waste disposal, adequate diet and clothing, and other measures were keys to keeping troops fit for battle. One of Washington’s first general orders, in 1775, addressed measures for maintaining soldiers’ health; such orders would be frequently repeated throughout the War of Independence, as camp commanders didn’t always comply.

A sketch of a nurse tending to a solider in the revolutionary war period.
Sketch of a nurse tending to a solider. Washington began to inoculate and quarantine troops to control and minimize the impact of the smallpox. His decision was bold and dangerous, as inoculation brought risk of death, although far less frequently than if contracting smallpox naturally.

Washington’s health-related orders also addressed inoculation against smallpox, a dangerous and highly contagious disease. Inoculation was risky as it used material from an infected person (rather than vaccination using cowpox material, which was developed later) to produce (one hoped) a mild infection and consequent immunity. Civilians also took a chance with the procedure; an outbreak in Boston in 1776 spurred Abigail Adams (wife of John Adams) to get herself and her children inoculated against it, though it took several of them weeks to recover.

An illustration of the Cinchona tree.
The bark of the Cinchona tree, a source of Quinine, was the bark in the “bark and wine” cure.  Madeira wine was the wine portion of the cure.  Secretary of the Treasury and leading Federalist Alexander Hamilton favored the “bark and wine” treatment for yellow fever.

These health burdens on the population, in Philadelphia and elsewhere in the colonies, were ubiquitous but insufficient to sway the colonies in their determination to be free of British rule. In spite of their administrative concerns and personal health complaints, the delegates to the Second Continental Congress made history on July 4, 1776.

After the revolution, Rush wrote an essay: “An account of the influence of the military and political events of the American revolution upon the human body” and another: “The result of observations made upon the diseases which occurred in the military hospitals of the United States, during the late war” an early usage of the nation’s new name.

You can find Rush’s essays in NLM Digital Collections and learn more about the health and politics of the early years of the United States NLM’s exhibition Yellow Fever in Alexander Hamilton’s America.

Dr. Speaker has been Historian for the Digital Manuscripts Program in NLM’s History of Medicine Division since 2002. She conducts research, selects documents, and writes in-depth contextual narratives for the Profiles in Science project, and she carries out other historical work including articles, blog posts, presentations, and oral histories on a variety of topics. She is also the historical consultant for the NLM Web Collecting and Archiving Working Group.

Elizabeth Mullen is Manager of Web Development and Social Media in NLM’s History of Medicine Division.  As managing editor of Circulating Now, she is privileged to work closely with many creative and dedicated NLM staff members and a wide range of historians, artists, curators, students, educators, and members of the public who have found meaning in the collections and shared their enthusiasm for the history of medicine.

Erika Mills is an exhibit specialist for the Exhibition Program in NLM’s History of Medicine Division. She has co-curated exhibitions on a collection of images from the World Health Organization and the first history of the NLM as presented in the institution’s first exhibition. Ms. Mills has worked at NLM since 2005, starting out as the community outreach coordinator for the Exhibition Program.

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