Benjamin Rush, Bloodletting, and the Philadelphia Yellow Fever Epidemic of 1793

A warmer-than-usual summer in 1793 brought on more than just potent aromas in Philadelphia. As ships entered the port city with cargo and passengers, the city was bustling with commerce, but underneath the hustle and bustle lay brewing a brood of infected mosquitos ready to spread disease to the citizens of the city.
For the month of January, the Museum has selected Benjamin Rush’s medicine chest as its featured item. Inside the chest are lead pills for the treatment of cholera and diarrhea, mercury used for creating balms and salves, and other various instruments. But who was Benjamin Rush, and how did he cement himself into Philadelphia’s medical history?

Benjamin Rush was one of the founding members of The College of Physicians and one of the most prominent names in colonial-era American medicine. He remains well known for his care of Yellow Fever patients during this period, specifically his application of aggressive bloodletting as one of his preferred treatments. 

What made the 1793 epidemic so devastating to the city when so many Yellow Fever epidemics had come before? To understand the answer, we must examine the disease. 

Yellow Fever is transmitted to humans through the bite of an infected mosquito. Breeding grounds for mosquitoes typically include stagnant water and warm climates, such as the balayage water at the base of boats, which made the port city of Philadelphia a perfect mosquito breeding ground. It is theorized that French Sailors, soldiers, and individuals fleeing Haiti after the first successful revolt led by enslaved individuals brought the disease with them to the city via mosquitos hitching a ride in their boats.

After being bitten by an infected mosquito, people may begin to show symptoms of Yellow Fever. Initial and more mild symptoms include fever, fatigue, nausea, and chills lasting approximately seven days before resolving. However, one out seven patients will develop more severe symptoms, such as bleeding, jaundice, high fever, shock, and organ failure. The jaundice caused by liver failure causes the skin and, predominately, the eyes, to turn a hue of dandelion yellow, giving the disease its name. Once the patient has reached the more severe stage of symptoms, the likelihood of their recovery diminishes. The CDC cites that those who develop severe symptoms have between a 30 to 60% chance of recovery; even today, with the interventions of modern medicine, Yellow Fever has no effective treatment. However, we do have strong preventative measures in the forms of a vaccine used in conjunction with mosquito repellant. It is recommended that if you are traveling to areas around the world that have a higher incidence of Yellow Fever, such as tropical environments, that you speak with your doctor for appropriate preventative measures.

Though Yellow Fever was common for the time in 1793, it posed a problem for the port city as doctors and researchers could not establish the main cause and, therefore, a treatment for the disease. These existing factors made it even more terrifying when, on August 27, 1793, members of The College of Physicians and the mayor of the city advised that if people were able to flee the city, they should do so. During this wave of the epidemic, 20,000 people, including doctors, fled while others remained to help treat those infected or were unable to leave the city. A explains that most Black residents of Philadelphia remained within the city to aid those stricken by the illness. Benjamin Rush himself is quoted as saying, “‘Parents desert their children as soon as they are infected, and in every room you enter you see no person but a solitary black man or woman near the sick.’” A belief held by some physicians was that Black people were not susceptible to the disease; however, as the above PBS article points out, “the belief in immunity turned out to be unfounded.” Instead, it was a belief that emerged from the period’s highly problematic racial science that posited significant physiological differences between the races as a means to justify exclusionary and oppressive practices, including slavery. The leaders of Philadelphia’s Black community, like Richard Allen and Absalom Jones, saw staying in the city to assist the sick as their civic duty. Within months, thousands had fled, and about 10% of the population of the city had died of Yellow Fever.

With the city empty and the smell of death in the air, Benjamin Rush was determined to find a treatment within established medical methods. He settled on the use of mercury (featured in his medical chest) and bloodletting. The theory of depletion, as bloodletting is sometimes known, is a key therapeutic part of the humoral system of disease theory, which held that “health” was found in balancing the four “humors” or vital bodily fluids: yellow bile, black bile, phlegm, and blood. In Rush’s day, the use of bloodletting had dominated medical literature since the time of the Romans and had become an established treatment essential in treating fevers (blood was a “hot” humor, and an excess of it would cause a fever. Reducing the amount of blood reduced the amount of heat in the body, theoretically restoring it to a more balanced state of health). Bloodletting was accomplished through several methods, varying from using leeches to cutting or puncturing the skin with various instruments. 

Physicians practiced bloodletting often during the 18th century, often in a small-scale way that did not pose a risk to the patient. Because Yellow Fever was such a severe disease, some physicians—notably Benjamin Rush—believed it required a far more aggressive plan of bloodletting. But this approach was not without controversy: if too much blood was removed, patients risked going into hypovolemic shock, a condition brought on by lack of fluid volume in the body, with symptoms ranging from fatigue and confusion to low blood pressure and an increased heart rate. Infection was also a serious concern, as the instruments that were used were not typically sanitized between applications. But with death raging in Philadelphia, Rush saw aggressive bloodletting as a risk worth taking. 

Even though they might seem harsh today, Benjamin Rush was using the treatment methods available to him during this dark time in Philadelphia’s history. Toting around his medicine chest filled with tinctures, pills, and instruments—for better or for worse—Rush attempted to treat those inflicted with this horrible fever when many of his peers did not. 

For more Benjamin Rush and bloodletting related collection objects, please check out our .  

Work Cited 

• Britannica, T. Editors of Encyclopaedia. "leech." Encyclopedia Britannica, December 21, 2024.
• “Epidemic in Philadelphia,” PBS, (Accessed on January 26, 2025) 
  
• Fleam | c. 1840-1860, 1651.1125.1
  
• ”Hypovolemic Shock, ”Cleveland Clinic, Last Modified: 04/16/2022. 
  
• Morales, R. Isabela. “Marcus Marsh and Benjamin Rush in Philadelphia: The Epidemic of 1793.”    Princeton & Slavery Project. accessed January 27, 2025. 
  
• Nicola, Stephanie reviewed by Dany Paul Baby, MD, " What to Know About the History of Bloodletting” Reviewed on April 20, 2022. 
  
• Prinzi , Andrea. “History of Yellow Fever in the U.S.” The American Society for Microbiology, May 17, 2021.
  
• “Yellow Fever: Causes and How It Spreads.” U.S Centers For Disease Control and Prevention. May 15, 2024.  
  
• “Yellow Fever: Symptoms, Diagnosis, and Treatment. ” U.S Centers For Disease Control and     Prevention. May 15, 2024. 
  
• Wang, yy; Fan HW; Huang, XM; Jiao,Y. ”Disseminated Staphylococcus aureus infection after    scarification wet cupping therapy: a case report and literature review.” BMC Complement Med Ther. 2023; 23(1). P doi:10.1186/s12906-023-03932-x