The history of disease in the U.S.

Past & Present: American Persistence in the Face of Devastating Epidemics
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"I have resolved to stick to my principles, my practice, and my patients to the last extremity."

— Dr. Benjamin Rush ([link removed]) , signer of the Declaration of Independence and leading physician, on the 1793 yellow fever epidemic

COVID-19 is not the first contagious pandemic to affect our nation—Americans have historically been very familiar with epidemics and their devastating impact.

Our nation's preparedness for the coronavirus epidemic has come under fire. While various factors may have affected our response, this crisis underscores the importance of teaching our country's history. New generations must learn from our past if they are to be prepared for the future—not just for a health crisis, but so they can heed the broader lessons our history teaches us.

How did America historically respond to deadly epidemics?
Thanks to medical innovations, persistence, and the heroism of individual citizens, our country prevailed. Scroll down to read more.

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The Yellow Fever Epidemic of 1793
The yellow fever epidemic of summer 1793 devastated Philadelphia, the largest American city and our nation's capitol at the time. 4,000 - 5,000 residents, about one-tenth of the city's population, died as a result.
The disease, spread by mosquitoes brought from warmer climes, caused high fever and internal bleeding. As the disease spread, citizens (including Thomas Jefferson and George Washington) fled the city, Congress was moved, and the city was quarantined.

Although the cause of yellow fever was unknown at the time, citizens still made efforts to stop its spread and care for the sick and dying. Dr. Benjamin Rush, a signer of the Declaration of Independence and Founding-era political figure, was also a leading physician in fighting the fever. He called for better sanitation measures and developed his own purging method of treatment. Philadelphia's free African-American population also played a crucial role, volunteering as nurses and grave-diggers (those of African descent were mistakenly thought to be more resistant to the disease). Other cities sent relief in the form of food, supplies, and money.

The epidemic abated in November when conditions for mosquitoes became untenable. The fever had left much of the city ravaged, but also left a legacy of improved administrative response to crisis. The city's hospitals, orphanages, and sanitation gained public priority.
Read more about the 1793 Yellow Fever Epidemic:
* "Philadelphia Under Siege: The Yellow Fever of 1793" by Samuel Gum (Pennsylvania Center for the Book, Penn State University, Brandywine) ([link removed])
* "America's oldest quarantine hospital tied to Philadelphia yellow fever history" by Jeanette Woods (WHYY PBS's The Pulse) ([link removed])

Cholera Pandemics, 1832-1873
Americans endured several cholera pandemics beginning in 1832. The largest outbreaks in 1832, 1848-49, 1866, and 1873 were devastating, killing approximately half of those infected. More than 200,000 Americans are believed to have died as a result.
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Cholera, spread by contaminated food and water, caused intense bouts of vomiting and diarrhea that resulted in dehydration and death. The disease, originating in Europe and Asia, affected port cities such as New York and New Orleans first.

Improving trade routes, while a boon to our developing country, also carried the infection inland. Small town America and cities alike suffered. During the 1849 pandemic, Gallia County, Ohio reported over a hundred cases - catastrophic in a small population. Ordinary citizens in small towns did their best to combat a disease with an unknown cause - in Gallia, Mr. Middleswarth, a farmer with no medical training, is credited with nursing the sick and attempting to implement a cure.

As in the case of yellow fever, citizens and physicians alike didn't yet know how the disease was transmitted. Many city-dwellers mistakenly presumed the disease was caused by moral deficiencies in the lower classes, the hardest hit segment of the population. Thousands of New Yorkers fled the city during the 1832 pandemic as Fourth of July events were cancelled and stores closed. Those that remained burned tar and meat to prevent vapors from what they believed was an airborne sickness.

By 1860, physician John Snow had pinpointed the cause of infection by mapping the spread of cholera through London and linking it to specific sources of drinking water. Sanitation efforts and safer water supplies greatly reduced future outbreaks and spread of the disease.
Read more about 19th Century Cholera Pandemics:
* "The 1849 Cholera Epidemic" by Neil Elvick (Gallia History) ([link removed])
* "Mapping History: Cholera" (Mapping History, University of Oregon) ([link removed])
* "Cholera in Nineteenth Century New York" (Virtual New York, City University of New York) ([link removed])
* "A history of cholera in New York City" by Greg Wiszniewski (BusyBee) ([link removed])

The 1918 Influenza Pandemic
In summer 1918, one of the deadliest pandemics of modern times spread across the world. The 1918 flu, also known as the Spanish flu, killed over 50 million people worldwide and roughly 675,000 in the United States from 1918-1922.The flu's spread was exacerbated by the worldwide transport of troops during World War I. It is estimated that 25% of the U.S. population was infected.
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The flu had normal flu symptoms - fever, aches, sore throat - but additionally caused fluid in the lungs and bleeding. Victims could die in a mere 2-3 days of showing symptoms. Many victims were healthy young adults as opposed to children or the elderly.

Philadelphia was the American city worst affected and had the highest death toll in the nation. At the flu's peak, hundreds of people died each day. Hospitals quickly filled to capacity, schools were closed, and public gatherings were banned. The morgues filled, then the 5 temporary morgues filled as well. The city government was overwhelmed and citizens soon became volunteer nurses, undertakers, and foster parents for newly orphaned children.

Although there was no cure nor vaccine for the flu, cities battled the disease with quarantine measures, closures, and public health announcements encouraging masks and little to no contact with others. World War I had called many medical personnel to military duties, leaving a shortage of doctors. Medical students offered their services, helping to fill the gap as nurses risked their lives working round the clock.

By the conclusion of the pandemic, the 1918 flu had become a valuable teaching tool for how to handle future pandemics. Even today, public health officials and epidemiologists are able to learn from 1918 data and better prepare for public health emergencies such as the coronavirus.
Read more about 1918 Influenza Pandemic:
* "Calm, Cool, Courageous: Nursing and the 1918 Influenza Pandemic" (Barbara Bates Center for the Study of the History of Nursing, Penn Nursing) ([link removed])
* "Penn and the 1918 Influenza Epidemic" by Mira Shetty (Penn University Archives & Records Center) ([link removed])
* "Rapid Response was Crucial to Containing the 1918 Flu Pandemic" (National Institutes of Health, U.S. Department of Health & Human Services) ([link removed])

Other Epidemics from Our History
The epidemics above are just a few of the many that our country has faced. Others include smallpox (prevalent 17th-19th centuries), scarlet fever (1858), typhoid fever (1906-1907), diphtheria (1921-1925), polio (1894,1916-1952), and HIV/AIDS (1981-2000).

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We the People Podcast: Civil Liberties and COVID-19
Some of Americans’ most basic civil liberties are typically exercised in person. As states enforce the stay-at-home orders necessary to prevent the spread of coronavirus, how will those rights be impacted? And what will happen to them after the crisis is over?
Our friends at the National Constitution Center discussed these questions in the latest episode of its We the People podcast. ([link removed]) Experts Lata Nott ([link removed]) and David French ([link removed]) joined host Jeffrey Rosen ([link removed]) to weigh in.
Click here to listen to the podcast >> ([link removed])

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About the Jack Miller Center

The Jack Miller Center is a 501(c)(3) public charity with the mission to reinvigorate education in America's founding principles and history. We work to advance the teaching and study of America's history, its political and economic institutions, and the central principles, ideas and issues arising from the American and Western traditions—all of which continue to animate our national life.

We support professors and educators through programs, resources, fellowships and more to help them teach our nation's students.

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