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Then and Now: The Long Confusing Road to Answers After Epidemics

K.A. Woytonik, Ph.D. Candidate, University of New Hampshire

 

Staff of the 'Doctors without Borders' medical aid organization carry the body of a person killed by the Ebola virus.

Staff of the ‘Doctors without Borders’ medical aid organization carry the body of a person killed by the Ebola virus. The Independent.

In current events, constant and thorough reporting on epidemics – lately Ebola devastating West Africa – produce debates over the protection of the public’s health. The recent evacuation of two American aid workers who contracted Ebola while treating patients in Liberia sparked great controversy.[1] Meanwhile, as Americans took to Twitter and comment sections to oppose the arrival of the Ebola patients in Atlanta, West African nations closed their borders and attempted to control mobs, like one in Liberia’s capital city of Monrovia that attacked a treatment center and inadvertently flushed the frightened patients from the isolation of the hospital out into the city.[2] Center for Disease Control officials and West African doctors alike struggled to quickly and effectively convince residents that protocols would keep them safe. They face a challenge that has stymied physicians for centuries.

Quarantine, isolation, and notions of contagion are pervasive debates in the history of medicine. In a well-known episode in American history, yellow fever decimated Philadelphia in 1793. An estimated 5,000 residents succumbed to the disease, including doctors and nurses treating the sick. By the end of the scourge in November, the city’s population was reduced by half due to death, illness, and citizens who fled in fear of contracting the disease.

Bush Hill, a country home belonging to William Hamilton and rented by John Adams, became an off-site hospital for yellow fever patients, who were removed from central Philadelphia.

Bush Hill, a country home belonging to William Hamilton and rented by John Adams, became an off-site hospital for yellow fever patients, who were removed from central Philadelphia.

Philadelphia’s existing healthcare institutions, including the marine hospital, the Pennsylvania Hospital and the almshouses, were not primary sites of care in the epidemic. Despite attempts to remove patients to the Bush Hill makeshift hospital and away from the city, people continued to fall ill in Philadelphia. Physician Benjamin Rush, believing those of African descent were immune to yellow fever, called upon black Philadelphians to nurse the sick. Absalom Jones and Richard Allen described how “a solicitation appeared in the public papers, to the people of colour to come forward and assist the distressed, perishing, and neglected sick; with a kind of assurance, that people of our colour were not liable to take the infection.”[3] Jones and Allen noted that the black nurses and attendants were often mistreated, underpaid, and ultimately many succumbed to the disease despite notions of immunity.[4] Physicians could not agree on the origins of the disease, a method of cure, and a course of treatment. But what historical treatment of the 1793 episode can eclipse is the lingering confusion over contagion that persisted into the next century.

Absalom Jones, a former slave who later became a minister, recounted both racial discrimination and the horror of the yellow fever epidemic in response to claims that black residents of Philadelphia had not done enough to assist in the public health crisis. Delaware Art Museum.]

Absalom Jones, a former slave who later became a minister, recounted both racial discrimination and the horror of the yellow fever epidemic in response to claims that black residents of Philadelphia had not done enough to assist in the public health crisis. Delaware Art Museum.]

While on a research fellowship from the Philadelphia Area Center for History of Science, I had the opportunity to work with a set of documents housed at the Philadelphia College of Physicians Library that I had long waited to see. Between 1820 and 1822, physician Nicholas Chervin conducted a survey on doctors’ opinions on whether or not yellow fever was contagious. Fifty-six physicians from Philadelphia, many of whom were active during the 1790s outbreaks, responded to Chervin’s inquiry.[5] The responses, though altogether slightly favoring non-contagion, were at best confused and at worst self-contradictory. Dr. Samuel Griffitts suggested that he had never seen a patient twice infected with yellow fever, but refused to rule out “the possibility of re-infection, which many physicians believe in.”[6] Thomas Parke relied on miasmatic theory – the notion that putrefaction, foul air, or decay could cause disease – to explain why yellow fever first appeared at the riverfront and then spread inward, leading him to believe it was not contagious. But Parke demurred on the subject of contagion, writing that since no one had “yet unanimously settled in the opinion of our medical Gentlemen, I leave the decision of the question to future investigation” – the very investigation Dr. Chervin was attempting to undertake.[7] And physicians took Chervin’s survey as an opportunity to voice their frustrations that scholarly debate over contagion was actually impeding science and treatment: “medical men by taking it up warmly have only involved themselves in endless logomachies, for like champions they arrange themselves on opposite sides and obstinately resist all conviction.”[8]

Historians of medicine are understandably cautious about directly comparing the past’s pestilence to modern-day epidemics. Of course, as it turned out, yellow fever is transmitted to humans by mosquitoes, whereas we know Ebola to be a communicable disease. Nonetheless, the aftermath of medical debate after 1793 on yellow fever, when the public was well and attention no longer fixed on the disease, might remind us that the legacy of epidemics transcends headlines, breaking news, and even the outbreak itself.

 

K.A. Woytonik, “Then and Now: The Long Confusing Road to Answers After Epidemics,” Khronikos: the University of Maine graduate history student blog (blog), September 10, 2014, http://khronikos.com/2014/09/10/then-and-now-the-long-confusing-road-to-answers-after-epidemics/.

K. A. Woytonik is a PhD Candidate in the History department at the University of New Hampshire, and a research fellow at the Philadelphia Area Center for the History of Science and the American Philosophical Society. Email:  ka[iv]i763@unh.edu  Twitter:  @SonicWoytonik


[1] http://time.com/3075848/cdc-ebola-patient-improving/

[2] http://www.pbs.org/newshour/rundown/raid-ebola-clinic-sparks-new-fears-infection-patients-flee/

[3] Absalom Jones and Richard Allen, A Narrative of the Proceedings of the Black People, during the Late Awful Calamity of Philadelphia, in the year 1793. Philadelphia: William Woodward, 1794, 3.

[4] Ibid, 11.

[5] Nicholas Chervin letters, “Opinions of Philadelphia Physicians Regarding Yellow Fever”, College of Physicians of Philadelphia MSS 2/0141-01-02.

[6] Ibid. Letter from Samuel Griffitts to Nicholas Chervin. May 16, 1821.

[7] Ibid. Letter from Thomas Parke to Nicholas Chervin. May 25, 1821.

[8] Ibid. Letter from William Barnwell to Nicholas Chervin. April 20th 1821

Image Credits:

http://www.independent.co.uk/news/world/africa/west-accused-of-tardiness-over-ebola-outbreak-9644671.html

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