Monday, July 28, 2008

Bring Out Your Dead: The Great Plague of Yellow Fever in Philadelphia in 1793. (1)

J.H. Powell
New York: Time Incorporated
1949 (1965)

Why read it? The anatomy of a crisis. How this particular crisis--the yellow-fever epidemic in Philadelphia in 1793--was dealt with. Ultimately, it was not resolved by human effort, but by nature's change of seasons, the frost that killed the real culprit, the mosquito. But to some degree the crisis was dealt with by people.

The first need was firm leadership, in this case, the mayor of Philadelphia, Matthew Clarkson, who did not desert his duties or the city. Second was the need for organization--to identify the many complicated problems within the crisis and then to set out to deal with them in an organized and efficient manner, from picking up and burying the dead to managing a hospital, Bush Hill, away from the city. The need to deal with the many excuses or obstacles to getting things done. Ultimately, the greatest need was to give hope and confidence to both victims and survivors. How to deal with fear and panic. (Another example of the power of organization and firmness in making decisions can be found in John Hersey's Hiroshima about the aftermath of the atomic bomb in Japan.)

Help came from both well-known people and ordinary citizens who did not desert the city, including black people. Matthew Clarkson, the mayor, did everything he could to help organize its remaining citizens and Stephen Girard, the future philanthropist, organized and managed the hospital at Bush Hill. Absalom Jones and Richard Allen were two of the many blacks who helped their white brethren. Also helpful was financial assistance from people, including those from outside the city, rural areas in Pennsylvania, and from other states, New Jersey and New York, in paying for needed services, like transporting and burying the dead. But these areas also refused to admit Philadelphians who, they thought, would infect their own inhabitants. The resistance to admitting Philadelphians, at times, bordered on persecutions.

What about the professionals in the field? Like doctors today, the doctors in this epidemic were able to agree on the description of the disease, but were bitterly antagonistic toward each others' theories about causes and suggested cures. The essential disagreement was whether the epidemic came from bodies (infectiousness) or from an external source, like the poisonous city fumes. Today, we know that the cause was from the bite of an infected female mosquito and that the infection cannot be spread from one person to another. The disease was not infectious.

In 1793, the theories of how to stop the epidemic were sometimes extraordinary: camphor, vinegar, wearing tarred ropes, shooting off guns to clear the air in and out of houses and burning bonfires in the streets and on street corners to clear the air. Common sense--like washing the streets and picking up the garbage--didn't help reduce the epidemic, but, from a sanitary point of view, improved the environment. When the federal government returned to the city at the end of the yellow fever epidemic, its members found clean streets.

In short, the professionals did not know and could not agree on the cause of the problem which they were trying to treat. The complex heroism of Benjamin Rush is an example. His extravagant purging and blood-letting were wrong and probably killed many more than he was able to cure, but his confidence, his assurance, his calmness, and his conviction that his methods were right gave confidence to his patients and to the rest of the surviving citizens who worshiped him. However, his bitter disagreements with his fellow professional physicians over his purge and bleed strategy, which he was absolutely sure was the best way for treating the illness, expended his valuable energy on anger and vituperation at the expense of his patients and of learning about the disease through cooperation with everyone trying to combat it.

What can we learn about dealing with crisis from reading this book about a crisis in Philadelphia in 1793? The leadership and decision-making must be firm, action must be organized and the goal must be to give survivors hope. Every effort must be made to resist panic. Professionals need to work together, rather than to antagonize each other by clinging to and arguing about unproven theories.

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