Encyclopedia of Greater Philadelphia

Yellow Fever

Reader-Nominated Topic

For more than a century beginning in the late seventeenth century, sudden outbreaks of yellow fever sowed death and panic throughout Philadelphia and its environs. With medical science seemingly powerless against it,  yellow fever was a terrifying and mysterious threat that rivaled any disease of the era in its capacity to take lives and disrupt society.

Yellow fever is a Flavivirus that spreads among humans via the bite of Aedes aegypti mosquitoes. Once introduced to a human host, the virus begins replicating in the lymph nodes. Initial symptoms include aches and pains, fever, nausea, and dizziness, lasting several days before receding. In serious cases, the symptoms return with renewed intensity as the disease spreads to the liver, inducing jaundice, delirium, and internal hemorrhaging. The victim begins bleeding from the ears and nose, retching up a blend of gastric contents and blood known as the “coffee grounds” or “black vomit.” In the terminal phase, the victim falls comatose as his organs and circulatory system begin to fail, usually expiring as the liver or kidneys finally give out, some 7-10 days after the relapse.  Those who survived the ordeal acquired immunity to the disease, but any population composed largely of unseasoned newcomers provided a fertile environment for an outbreak.

Epidemiological evidence suggests that both the virus and its vector originated in Africa. They crossed the Atlantic by the slave trade, becoming endemic in the sugar islands of the West Indies. Once established there, it was only a matter of time before the fever spread to North American ports. From its earliest days, Philadelphia carried on a bustling trade with the Caribbean, and a “Barbados Distemper” struck the city in 1699, felling 220.

For almost a century, yellow fever was an erratic visitor, abruptly appearing after long intervals of relative inactivity. Significant outbreaks appeared in 1741, 1747, and 1762, but major episodes were too uncommon and unpredictable to have a broader political impact until the 1790s, when the fever began striking with greater frequency and fury.

1793: Yellow Fever Returns

After some three decades absent, yellow fever returned to Philadelphia with a vengeance in 1793, during the period that it served as the capital of both Pennsylvania and the United States. Beginning from a cluster of infections near the Delaware waterfront, the fever spread rapidly through the summer and autumn, fueling panic throughout the city. Those who could fled the city to destinations in healthier countryside, like Germantown and Gray’s Ferry, an exodus numbering in the thousands. Among those who remained, the fever claimed an estimated 5,000 lives. Other American cities embargoed the nation’s capital, fearful that traffic from Philadelphia could introduce the infection.

Officers of federal, state and municipal government vacated the city, leaving management of the crisis to Mayor Matthew Clarkson and a committee of volunteers led by merchant Stephen Girard, who organized a fever hospital at the Bush-Hill mansion built by Andrew Hamilton. Black Philadelphians served in disproportionate numbers, owing to a widely held belief that they were immune to the fever, and their heroic service as nurses, porters, and inspectors is widely regarded as a formative event in the history of black Philadelphia. When printer Mathew Carey published an account of the crisis impugning the conduct of African-American volunteers, black church leaders Absalom Jones and Richard Allen responded by publishing a powerful rebuttal of the charges, forcing Carey to amend later editions of his tract.

The epidemic also set off a wide-ranging debate over the cause of the fever and the best means of controlling it. Philadelphia’s College of Physicians contended that it was both contagious in nature and foreign in origin, while a faction led by Benjamin Rush, the city’s most celebrated doctor, argued that only domestic environmental factors were to blame. Incorporating insights from both parties, Pennsylvania established a new Philadelphia Board of Health in 1795 to enforce both quarantine and sanitary regulations.

1793: The Model Response

Notwithstanding the new measures, the fever returned seven times in the following twelve years, and 1793 set the model for how Philadelphians responded to subsequent outbreaks. Each episode spurred similar patterns of evacuation, isolation, and scapegoating, and stoked the ongoing controversy within the medical community and motivated broader, though futile, efforts to ameliorate the effects of the disease. Nursing may have offered some comfort, but only winter frost—and its extermination of the mosquitoes—brought an end to each fever year.

The ordeal of fever had a profound effect on the city and the country. It was one of several factors in Philadelphia’s decline relative to rising ports like New York City. It inspired literary and journalistic development as writers and printers discussed, described, and debated the disease. The urban nature of the fever fueled the agrarian romanticism of the Jeffersonian era. And throughout the country, and the broader Atlantic World, medical men struggled to understand a foe that thwarted their best efforts.

Yellow fever struck Philadelphia and other northern ports only sporadically after 1820, but it remained a persistent problem in the American South until the turn of the century, when researchers like Carlos Finlay and Walter Reed unraveled the etiology of the disease and formulated effective measures to control it.

map of yellow fever deaths

Map produced by Billy G. Smith and Paul Sivitz, Montana State University.

Simon Finger holds a Ph.D. from Princeton University and is the author of The Contagious City: The Politics of Public Health in Early Philadelphia (Ithaca, N.Y.: Cornell University Press, 2012).

Essay Copyright 2011, University of Pennsylvania Press.

Related Reading

Estes, J. Worth, and Smith, Billy G. A Melancholy Scene of Devastation: The Public Response to the 1793 Yellow Fever Epidemic. Philadelphia: Science History Publications/USA, 1997.

Finger, Simon. The Contagious City: The Politics of Public Health in Early Philadelphia Ithaca: Cornell University Press, forthcoming 2012.

McNeill, J.R., Mosquito Empires: Ecology  and War in the Greater Caribbean, 1620-1914, New York: Cambridge University Press, 2010.

Miller, Jacqueline. “The Body Politic: Passions, Pestilence, and Political Culture,” Ph.D. Diss., Rutgers University, 1995.

Powell, J.H. Bring out Your Dead: The Great Plague of Yellow Fever in Philadelphia in 1793. Philadelphia: University of Pennsylvania Press, 1949.

Taylor, Sean, “‘We Live in the Midst of Death’: Yellow Fever, Moral Economy, and Public Health in Philadelphia, 1793-1805.” Ph.D. Diss., Northern Illinois University, 2001.


Pamphlets on yellow fever, The College of Physicians of Philadelphia, Historical Library & Wood Institute, 19 S. 22nd Street, Philadelphia.

Benjamin Rush Papers (including his correspondence on yellow fever epidemic), Medical Center Library, Duke University, Durham, N.C.

Female Association for the Relief of Women and Children in Reduced Circumstances Records, Magill Library, Haverford College, 370 Lancaster Ave., Haverford, Pa.

Places to Visit

The Lazaretto, Tinicum Township, Delaware County, Pa.
The Pennsylvania Hospital, 800 Spruce St., Philadelphia, Pa.
Mother Bethel AME Church, 419 S. Sixth St., Philadelphia, Pa.
The College of Physicians of Philadelphia, 190 S. 22nd St., Philadelphia, Pa.

8 Comments Comments

  1. I read the article with great interest. We had two priests at Old St Joseph’s RC Church,
    Willings Alley ( at that time it was known as St Joseph’s), they tended the victims of the fever and both died as a result.
    Maryjane Green
    OSJ Archivist

    Maryjane Green Posted October 6, 2011 at 4:39 pm
  2. I really liked this

    Nick Posted December 9, 2015 at 11:50 am
  3. This article was great for me I used it for a project and got an A on that presentation.

    Jager Klaassen Posted May 1, 2018 at 8:11 pm
  4. I’m doing research into our family history. We suspect that some family members were victims of the 1793 yellow fever epidemic, leaving their three children as orphans. Is it possible to find a listing of the victims and/or possibly the children left behind?

    Paula Posted June 2, 2018 at 9:03 pm
  5. What is the toxic stage

    Eliza Posted February 3, 2020 at 11:42 am
  6. I found this helpful for my Yellow Fever presentation for school. In my class I was the only one who chose Yellow fever. Everyone else chose the Black Death or Polio. Everyone was impressed by my presentation. Thanks to this article, I got an A.

    -Suzy Dodson
    CJHN 9 . 10 . 20

    Suzy Dodson Posted September 10, 2020 at 9:20 am
  7. It would be helpful if you put more about the mosquitoes. I almost had to go to a different website for more information about the 1793 Yellow Fever for my prodject.

    Kyra Posted November 3, 2020 at 10:36 am
  8. Thanks for the article, I got a sense of what it was like living during this time and how the disease spread. Thanks for the great info!

    June B Posted April 19, 2021 at 2:27 pm

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    […] Another resident I recognized was Benjamin Rush, patriot and man of medicine, in as much as that was possible at the time. His attitude toward bleeding was, alas, about the same as Theodoric of York. Still, he did what he could, especially during the yellow fever epidemic of 1793. […]

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