Few American cities have been as repeatedly devastated by epidemics as Philadelphia. Since the signing of the Declaration of Independence, Philly has weathered small pox, yellow fever, Dengue fever, influenza, polio, and AIDS. At the heart of each health crisis, the efforts of individuals have had profound impacts on the course of illness in the city–sometimes for better and sometimes for worse.
As the next modern epidemic looms in the fore of national public health official’s concerns, we take a look at three devastating disease outbreaks in Philadelphia’s history and the individuals that provided leadership in times of chaos, confusion, and dangerous misinformation.
Yellow Fever, 1793
Walking around Philadelphia in the early fall of 1793, one would find men firing cannons in the streets, doctors bathing in vinegar, and school children smoking cigars. These were all attempts to curb yellow fever, a poorly understood viral disease that was spreading rapidly throughout the city. Residents blamed Santo Domingan refugees, rotting shipments of coffee, and the unpredictable wrath of God. The mosquito, the vector by which the disease spread, was never a suspect.
“If you were in the medical practice of that era, you had no way to do any type of imaging in the body,” said Dr. Robert Hicks, director of the Mütter Museum of The College of Physicians of Philadelphia. “Everything was based on what the patient tells you, and what you see.”
The pace of the yellow fever outbreak paralyzed the city. The first newspaper report of the virus was published on August 23, 1793. By September 16, the city was burying at least 60 bodies a day. By the middle of the month, the death toll had reached 427, a time when Philadelphia’s population was only 55,000. Hospitals and graveyards filled up. People who had the means to flee the city did so, including most politicians and much of the city’s leadership. By the end of the month, Mayor Matthew Clarkson was running the City with a committee made up of anyone willing to show up and work.
Among those who stayed behind was Dr. Benjamin Rush, signer of the Declaration of Independence and a founder of the College of Physicians. Rush had a highly-regarded medical practice at Third and Walnut Streets. He and other remaining physicians ran themselves ragged treating the infected. On one particularly bleak night, Rush read an obscure manuscript that suggested the disease might be conquered with a combination of purging by mercury treatment and bloodletting. He tested the cure on a handful of individuals, including himself. When he became convinced of its efficacy, Rush prescribed it zealously.
Those who survived the disease while receiving Rush’s treatment did so in spite of it. But what Rush brought to a panicked city was the relief of authority.
In Bring Out Your Dead, J.H. Powell’s 1959 narrative history of the yellow fever outbreak, Powell writes, “The very firmness of his presence in the shuddering city brought hope, courage, and reassurance to many who had been paralyzed with panic… the courage he imparted to others was as healing as his purging and bleeding were probably destructive.”
Rush’s cure was a false one, but his commitment to the toxic treatment, and his ubiquitous presence in the city, gave Philadelphia a desperately needed psychological lift. And yet his commitment to the cure eventually ruined his reputation. As the disease progressed and other physicians had success with less aggressive treatments, Rush vehemently denied that anything but purging and bleeding could cure the disease. He bickered with other doctors in newspaper columns and claimed that anyone not following his cure was killing their patients.
On November 5th, as frost killed off the infected mosquitoes and the city began to slowly recover, Rush resigned from the College of Physicians.
Spanish flu, 1918-19
In September 1918, as World War I entered its final months, the United States leaned hard on Americans to buy war bonds. Treasury Secretary William McAdoo, responsible for financing the war effort, once proclaimed, “A man who can’t lend his government $1.25 a week at the rate of 4% interest isn’t entitled to be an American citizen.”
In Philadelphia, where the population had grown to 1.75 million, a big parade and concert were organized to promote the sale of war bonds. The Fourth Liberty Loan Parade, followed by a concert by John Philips Sousa, was scheduled for September 28.
As the parade approached, Dr. Wilmer Krusen found himself under pressure from the city’s medical establishment to cancel the event. Krusen was Philadelphia’s director of Public Health and Charities. Several doctors had called on him earlier that month to quarantine 300 sailors that had recently arrived at Philadelphia’s Navy Yard. The servicemen had come from Massachusetts, where a virulent outbreak of influenza had already caused the Army to cancel a draft call. Krusen refused the quarantine the men. As concerns about influenza grew, the medical community encouraged the cancellation of the Liberty Loan parade in the interest of avoiding crowds and ideal transmission conditions. Krusen refused these requests as well, and the parade went off as planned. At least 200,000 people crowded into Philadelphia’s streets. Within 72 hours, 31 of the city’s hospitals were full of new influenza cases.
Krusen soon took action against the outbreak. On October 7, he seized the City’s $100,000 emergency fund for measures to fight the disease and requested that the Army and Navy cease drafting Philadelphia doctors while they treated those stricken in the city. Krusen had streets cleaned and paid for the clearing of bodies. Despite these measures, the city registered 12,162 deaths from influenza between September 29 and November 2, a number that does not include those that succumbed to other conditions while fighting the disease.
Krusen could have lessened the death toll by mandating a quarantine or canceling the parade, but he operated in an environment that made such decisions almost unthinkable. Canceling a war bond parade in such a charged atmosphere would have pitted Krusen against the war effort and against the federal government. “The government would not publicly acknowledge the epidemic,” said Mütter Museum director Dr. Hicks, “because to do so would detract from the victory message.”
With Krusen, Philadelphians experienced the pandemic under a public health official that could not act in their best interests without risking becoming an enemy of the federal government.
Rashidah Abdul-Khabeer (formerly Rashidah Hassan) converted to Islam in 1979, just before the AIDS crisis struck Philadelphia. While finishing her nursing degree, Abdul-Khabeer read the Quran during a prolonged illness, elements of which helped her grapple with lifelong questions of faith, religion, and purpose.
“What stood out the most was that we are placed here solely to worship God, and there’s a whole list of ways that worship can be manifested. One of them is service to humanity, which tied back to my nursing,” said Abdul-Khabeer in an interview with the African American AIDS History Project in 2016. “And so there I landed, exactly where I was supposed to be. In the midst of all of that, up came the HIV epidemic.”
By 1985, African Americans accounted for 92 of Philadelphia’s 200 AIDS cases. Abdul-Khabeer was frustrated and wanted to take action. At the time she held a leadership position with Philadelphia Community Health Advocate’s AIDS Task Force, but she felt that PHCA and other groups mobilizing against the epidemic were not effectively reaching out to Black communities. In response, she co-founded the organization, Blacks Educating Blacks About Sexual Health. BEBASHI’s all-volunteer staff tapped into existing lines of communication in African American neighborhoods to spread awareness of the AIDS crisis. The group held special educational meetings for Black journalists and tenant groups and framed AIDS as an issue of Black survival in order to activate civil rights organizers.
In a 1992 interview with NPR Fresh Air host, Terry Gross, Abdul-Khabeer describes BEBASHI’s tactics for reaching at-risk populations, including visiting IV drug users in drug dens and talking with sex workers while they worked on the street. “When you look at it from a survival perspective,” said Abdul-Khabeer, “it really does strip away a lot of your fears about getting what needs to be done, done. And nobody else is doing it.”
BEBASHI specifically addressed concerns and misconceptions about AIDS held by the Black community. In the Fresh Air interview, Abdul-Khabeer said, “I had not a single presentation go without the question, ‘What about Tuskegee?,’” a reference to the syphilis experiment conducted by the U.S. Public Health Service on Black men in Alabama. Among the groups to which she presented, Abdul-Khabeer found concerns in the community that AIDS was a similar government program to experiment on and, some worried, eradicate the Black population. This belief was often held alongside the misconception that AIDS was a white person’s disease, an idea fueled by images of white gay men and white mothers and babies in AIDS literature.
BEBASHI’s approach was met with remarkable success. A 1989 study, published by the American Public Health Association, found that BEBASHI had direct contact with over 24,000 people in its first two years of existence.
BEBASHI continues to operate as a health management agency in Philadelphia with a focus on serving economically disadvantaged groups.
Anticipating the Next Epidemic
Like the Yellow Fever outbreak in 1793 and the 1918 Influenza pandemic, the physiological suffering during the AIDS crisis was compounded by confusion and deep psychological distress. At the outset of each epidemic, the questions of who would step up to provide leadership and care, how many might die, and what people could do to protect themselves were all unknown. Fear during the epidemics also fed into existing bigotry. During the Yellow Fever outbreak, Santo Domingan refugees were blamed as a source of the disease. During the AIDS crisis, homophobia and racism hobbled the federal response to the disease. Relief often came from non-governmental figures, people like the citizen’s committee that ran Philadelphia during the Yellow Fever outbreak or Rashidah Abdul-Khabeer and her small army of AIDS education volunteers.
“People have the impression that in the case of another epidemic, you’ll have government officials knocking on your door and letting you know what to do,” says Dr. Hicks. “And that’s not necessarily the case.”
Should another epidemic occur in Philadelphia, the experience will vary widely according to a person’s resources. “Social stratification is a major issue in all these epidemics,” said Dr. Carolyn Cannuscio, director of Research at the University of Pennsylvania’s Center for Public Health Initiatives. “You see more privileged people having greater autonomy and ability to respond to epidemic threats, and people of lesser means subject to the greatest risks.”
143,000 children make use of the Philadelphia School District’s free and reduced lunch program. “In the event of an emergency, is our city prepared to feed those children and their families for an extended period of time?” asked Cannuscio. “Unfortunately, I would say the answer is no. I think our city is prepared to feed a few hundred people for a couple days, but not a whole city worth of poor families or school children.”
The likelihood of such an event is extremely difficult to gauge, and trying to prepare for an epidemic on an individual level can be paralyzing. “In order to function, you have to believe the day is going to be a normal day, and yet, we want people to prepare for emergencies,” said Cannuscio. “It’s hard to integrate those things, and even people that are very well equipped financially and in terms of education still don’t do it.”
For insight into how epidemics start, Hicks and Cannuscio both had offerings. Hicks is in the planning stages of an exhibit at the Mütter Museum on the 1918 flu epidemic. The exhibit, Spit Spreads Death, opening in 2019, is a first-time collaboration between the museum’s curators and an interactive artist.
Dr. Cannuscio had a simple suggestion for more immediate action. “A lot of people die in the U.S. every year from flu, and a lot of people don’t recognize flu can be a deadly disease,” she said. “Wash your hands.”