An American Plague Summary and Analysis
An American Plague: The True and Terrifying Story of the Yellow Fever Epidemic of 1793 by Jim Murphy is a nonfiction account of the 1793 yellow fever epidemic in Philadelphia, then the temporary capital of the United States. The book explains how the disease spread through a crowded, dirty, mosquito-filled city and how fear, confusion, medical disagreement, and civic collapse followed.
Murphy also focuses on the people who stayed behind: doctors, city leaders, volunteers, and members of the Free African Society who cared for the sick despite danger and prejudice. The book is both a history of one deadly outbreak and a warning about how public health crises test science, government, and community.
Summary
An American Plague begins in Philadelphia during the summer of 1793, when the city is hot, crowded, and full of foul smells. Open sewers, rotting waste, dead animals, and standing water create unhealthy conditions everywhere.
Mosquitoes breed in the city’s water sources, though no one yet understands that they will become the central cause of the disaster. Philadelphia is the largest city in the United States and the temporary seat of the federal government.
President George Washington, Vice President John Adams, Thomas Jefferson, Alexander Hamilton, and other national leaders are all connected to the city’s daily life and political tensions.
At first, the sickness appears quietly. A French sailor becomes ill at a boardinghouse, and others nearby begin to suffer and die.
The symptoms are terrifying: chills, fever, headaches, body pain, yellowing skin and eyes, weakness, delirium, and black vomit. Benjamin Rush, one of Philadelphia’s leading doctors, realizes that the city is facing yellow fever, a disease he has seen before.
Other doctors are not convinced. Some believe the illness comes from local filth and bad air, while others believe it has arrived from the West Indies through ships and refugees.
This disagreement creates a serious divide among physicians at the very moment the city needs clear guidance.
As deaths increase, fear spreads quickly. Mayor Matthew Clarkson warns residents about a dangerous fever and orders the streets cleaned, but the disease continues to move through the city.
People who can afford to leave do so in large numbers. Many poor residents remain because they have nowhere to go.
Shops close, streets empty, church bells toll constantly for the dead, and the normal life of Philadelphia nearly stops. The city’s leaders struggle to respond.
The state government gives emergency authority to Governor Thomas Mifflin, but he leaves the city and gives the crisis to Mayor Clarkson without enough money or direction.
Clarkson tries to manage the disaster as workers, officials, doctors, and residents flee or fall sick. The city needs places to house the sick, especially poor people who cannot care for themselves.
At first, officials try to use an empty entertainment building, but neighbors object and threaten violence. The sick are then moved to Bush Hill, a mansion outside the main part of the city.
The building soon becomes overcrowded and badly run. Patients lie beside the dying and the dead.
There are too few doctors, too few nurses, and almost no order.
During this crisis, Benjamin Rush asks the Free African Society for help. Many white Philadelphians wrongly believe that African Americans are immune to yellow fever.
The Society, led by figures such as Richard Allen and Absalom Jones, agrees to help despite the racial discrimination its members face. Volunteers go through the city caring for the sick, helping abandoned children, carrying patients to Bush Hill, and assisting families in desperate conditions.
Their work is dangerous and exhausting. African Americans also become sick, proving that the idea of immunity is false.
Even so, they continue serving the city while also facing criticism over nursing fees and public suspicion.
Rush becomes one of the most controversial figures in the epidemic. He believes he has found an effective treatment through heavy purging and bloodletting.
His method uses strong doses of mercury and jalap to force the body to empty itself, followed by removing blood from patients. Many people trust him because he is respected, energetic, and willing to remain in the city.
Others condemn his methods as extreme and harmful. Rush himself becomes sick, uses his own treatment, recovers enough to return to work, and continues treating patients.
His confidence gives many residents hope, but his cure remains fiercely disputed.
As the city falls deeper into disorder, Mayor Clarkson forms an emergency committee to handle essential work. The committee has no full legal authority, but its members act because the city is desperate.
They borrow money, arrange food and supplies, pay workers, hire nurses and doctors, organize burials, and try to keep basic services running. Israel Israel helps distribute food, clothing, and firewood.
Stephen Girard and Peter Helm take charge of Bush Hill and transform it from a place of neglect into a more organized hospital. Helm manages the outside operations, including patient admission, coffins, water, repairs, and staff housing.
Girard cleans the interior, separates patients by condition, and improves nursing care. They also bring in Dr. Jean Devèze, who rejects Rush’s harsh treatment and uses gentler care.
By October, Philadelphia reaches its worst point. More than one hundred people die on some days.
Streets are dark, silent, and nearly deserted. People avoid one another in fear of infection.
Food, medicine, and housing become major problems. Some landlords exploit tenants, and theft increases.
Reverend J. Henry C. Helmuth walks through the city and sees suffering everywhere among his congregation and neighbors. The epidemic affects rich and poor, government leaders and laborers, white and Black residents, doctors and volunteers.
The fever also disrupts the national government. Washington leaves Philadelphia, and other officials scatter.
Because Philadelphia is the legal meeting place of Congress, leaders debate whether Congress can meet somewhere else. Jefferson and Madison argue that it cannot legally do so, creating a constitutional problem.
Washington receives incomplete and conflicting reports while away from the city and struggles to decide when to return.
Late in October, colder weather begins to slow the fever. The number of new cases falls, and people gradually return.
Washington rides into Philadelphia in November and finds the city cleaner and calmer. Shops reopen, government resumes, and daily life begins again, though survivors carry physical and emotional marks of the disease.
Thousands have died, with estimates ranging from four thousand to five thousand people.
After the epidemic, Philadelphia and the nation try to learn from what happened. Laws are changed so government can function better during emergencies.
The city improves its water system, eventually building one of the nation’s first major waterworks. Doctors continue arguing over the cause and proper treatment of yellow fever.
Rush’s reputation suffers as critics attack his methods. The emergency committee is praised for saving lives but also criticized for taking power without legal authority.
A major public conflict follows when publisher Matthew Carey writes an account that criticizes African American nurses. Absalom Jones and Richard Allen respond with their own account, defending the Free African Society and correcting Carey’s claims.
Their response becomes an important record of Black courage, labor, and public service during the epidemic.
The book then expands beyond 1793 to explain what scientists later learned. Yellow fever continues to strike cities throughout the nineteenth century.
For many years, people still do not know its true cause. Eventually, doctors and researchers connect the disease to mosquitoes.
Experiments by Carlos Finlay, Jesse Lazear, James Carroll, and Walter Reed help prove that the female Aedes aegypti mosquito spreads yellow fever. Later, scientists develop better prevention methods and a vaccine, but the disease is never fully erased as a threat.
By the end, An American Plague shows that the 1793 epidemic was not only a medical disaster but also a test of leadership, public trust, science, race, poverty, and civic duty. Murphy presents Philadelphia’s suffering as a historical event with lasting lessons: cities must prepare for disease, governments must act responsibly, science must keep advancing, and ordinary people often become essential in moments of public crisis.
Key People
Benjamin Rush
Benjamin Rush is one of the central figures in the account because he represents both medical courage and medical limitation. As a respected Philadelphia physician, he recognizes the danger of yellow fever earlier than many of his colleagues and tries to warn others before the crisis becomes impossible to ignore.
His willingness to remain in the city while other doctors flee or fall ill gives him an heroic quality, especially because he continues treating patients even after becoming sick himself. At the same time, Rush’s confidence in his harsh treatment methods makes him a deeply complicated figure.
His use of aggressive purging and bloodletting reflects the medical beliefs of his time, but the results are uncertain and often dangerous. In An American Plague, Rush is not shown as simply right or wrong; he is shown as a man trying to fight a terrifying disease with the limited knowledge available to him.
His stubbornness, energy, compassion, and pride all shape his role in the epidemic.
Matthew Clarkson
Matthew Clarkson, the mayor of Philadelphia, becomes a symbol of civic responsibility under extreme pressure. He is not presented as a perfect leader, but he is one of the few public officials who stays when the city begins to collapse.
His personal life is touched by the fever, yet he continues to appear at city hall and tries to organize a response as panic grows. Clarkson must deal with abandoned streets, fleeing officials, sick citizens, overcrowded hospitals, and a lack of money or clear authority.
His decision to create an emergency committee shows both desperation and practical judgment. Legally, the committee’s authority is questionable, but morally, it becomes necessary because no one else is managing the disaster effectively.
Clarkson’s importance lies in his steadiness. He cannot stop the fever, but he helps prevent Philadelphia from falling into complete disorder.
Richard Allen
Richard Allen stands out as a figure of moral strength, leadership, and public service. As one of the leaders of the Free African Society, he helps organize African American volunteers to care for the sick, transport patients, comfort families, and assist abandoned children.
His actions are especially significant because African Americans in Philadelphia face discrimination, disrespect, and false assumptions about their immunity to yellow fever. Allen’s choice to help the city is not based on public reward or equal treatment, because neither is guaranteed.
Instead, it reflects a strong sense of duty and community responsibility. When African American nurses are later accused of greed, Allen helps defend their work and reputation.
His role shows how people pushed to the margins of society can become essential during a public emergency, even when their sacrifices are not fully honored.
Absalom Jones
Absalom Jones is another key leader of the Free African Society and works closely with Richard Allen during the epidemic. His character is defined by service, dignity, and resistance to injustice.
Jones helps mobilize volunteers at a time when fear has weakened many of Philadelphia’s institutions. Like Allen, he understands that African Americans are being asked to risk their lives for a city that still tolerates slavery and racial prejudice.
Yet he does not respond with bitterness or withdrawal. He responds with action.
Later, when Matthew Carey publishes claims that criticize Black nurses, Jones helps answer those accusations and protect the historical truth of their service. His presence in An American Plague is important because he shows that heroism during a crisis includes both physical courage and the courage to challenge false public narratives.
Stephen Girard
Stephen Girard is portrayed as one of the most effective practical heroes of the epidemic. A wealthy merchant, he could have protected himself and stayed away from danger, but instead he takes responsibility for Bush Hill, one of the most chaotic and frightening places in the city.
His work inside the hospital is disciplined, direct, and humane. He helps clean the building, organize patients according to their condition, improve nursing care, and bring order to a place associated with suffering and neglect.
Girard’s courage is quiet rather than dramatic. He does not simply donate money or offer advice from a distance; he enters the place where help is most needed.
His character shows the value of hands-on leadership. Through his actions, Bush Hill becomes less of a death house and more of a functioning hospital.
Peter Helm
Peter Helm works alongside Stephen Girard and becomes essential to the transformation of Bush Hill. As a barrel-maker, he does not belong to the city’s political or medical elite, yet his contribution is one of the most practical and life-saving in the account.
Helm takes charge of the outside operations at Bush Hill, including admission procedures, water supply, staff housing, coffin-making, and the removal of the dead. His work is physically demanding and emotionally heavy, but he handles it with determination.
Helm represents the ordinary citizen who becomes extraordinary because the situation demands it. His role also shows that saving lives during an epidemic does not depend only on doctors.
Organization, sanitation, labor, courage, and persistence are just as necessary.
Jean Devèze
Jean Devèze provides an important contrast to Benjamin Rush. As a French doctor with prior experience of yellow fever in the West Indies, he brings a different understanding of the disease and its treatment.
He rejects Rush’s severe purging and bleeding methods and favors gentler care. His arrival at Bush Hill helps improve the hospital’s reputation, especially because patients under his supervision appear to receive more orderly and attentive treatment.
Devèze’s character highlights the conflict between competing medical theories during the epidemic. He also shows how experience from outside Philadelphia becomes valuable in a city that is struggling to understand what is happening.
His role is not only medical but also symbolic: he represents the possibility that careful observation and less aggressive treatment may be wiser than bold certainty.
George Washington
George Washington’s role in the epidemic is shaped by his position as president and by the limitations of leadership from a distance. He leaves Philadelphia as the fever spreads, and his absence creates a serious political problem because the federal government depends on the city as its meeting place.
Washington is not shown as indifferent; he seeks information and struggles to decide when it is safe and proper to return. However, the poor flow of reliable reports makes his decisions difficult.
His situation reveals how a public health crisis can threaten national government, not just individual lives. Washington’s character in this account is cautious, burdened, and constrained by constitutional uncertainty.
The epidemic tests not only his personal judgment but also the young nation’s ability to function under emergency conditions.
Thomas Jefferson
Thomas Jefferson appears as a political figure whose actions add to the sense of national instability during the fever crisis. His resignation as secretary of state comes during a period when Philadelphia is already losing officials, clerks, and public servants to illness or flight.
His disagreement with Washington’s neutrality policy toward France places him within the broader political tension of the time. Jefferson’s role also matters because he questions whether Congress can legally meet outside Philadelphia.
This concern helps turn the epidemic into a constitutional crisis. Through Jefferson, the book shows that disease does not pause political conflict.
Instead, it exposes weaknesses in government structure and makes existing disagreements more urgent.
Alexander Hamilton
Alexander Hamilton’s experience with yellow fever makes the epidemic personal for the federal government. He and his wife become sick, showing that status and power offer no complete protection from disease.
Hamilton also becomes part of the debate over Benjamin Rush’s treatment, criticizing the harsh methods Rush promotes. His role in the account is smaller than Rush’s or Clarkson’s, but it is still important because he connects the medical crisis to the nation’s leadership.
Hamilton’s illness reminds readers that the fever reaches into private homes as well as public offices. His skepticism toward Rush also reflects the wider uncertainty surrounding medical authority during the epidemic.
Reverend J. Henry C. Helmuth
Reverend J. Henry C. Helmuth provides a religious and moral perspective on the epidemic. Before the fever becomes widely recognized, he worries that Philadelphians are turning away from church and toward entertainment.
As the epidemic worsens, he walks through a city marked by silence, death, and fear. His interpretation of the disaster is shaped by his belief that the people have brought suffering upon themselves through moral failure.
Helmuth’s view may seem severe, but it reflects one common way people tried to make sense of disease before modern science could explain it clearly. His character shows the emotional and spiritual weight of the epidemic.
He is important because he records not only what the city looks like, but what the disaster feels like to those who see it as judgment and warning.
Matthew Carey
Matthew Carey is important less for what he does during the epidemic and more for how he shapes the public memory of it afterward. As a printer and publisher, he writes an account of the fever that becomes widely read.
However, his criticism of African American nurses creates a major controversy. Carey’s portrayal of their service is unfair because it downplays their danger, labor, and sacrifice while emphasizing accusations about high fees.
His character shows how history can be distorted by prejudice, self-defense, and incomplete testimony. The conflict between Carey and the Free African Society reveals that surviving a crisis is not the same as controlling its meaning.
Carey becomes a reminder that written accounts can influence public opinion, but they can also be challenged.
William Currie
William Currie represents the professional disagreement among doctors during the epidemic. He rejects Benjamin Rush’s certainty and opposes his aggressive treatment methods.
Currie believes the fever was imported rather than created by local conditions, placing him on the opposite side of a major medical debate. His role shows that even educated physicians lacked agreement about the disease’s origin, spread, and treatment.
Currie is significant because his skepticism prevents the medical community from appearing unified. This division increases public confusion, but it also reflects a realistic struggle within early medicine.
Doctors were trying to act scientifically, but they were still limited by old theories and incomplete evidence.
Philip Freneau
Philip Freneau, the editor of the National Gazette, offers a different kind of response to the epidemic. While other newspapers focus more directly on fever news, Freneau often uses humor and light verse to give readers a break from fear and death.
His role shows that people need emotional survival as well as medical care and government action. In a city where death is everywhere, even small attempts at distraction matter.
Freneau’s humor is not a denial of suffering; it is a coping method. Through him, the account shows how language, newspapers, and public tone shape the way people endure disaster.
Andrew Brown
Andrew Brown, editor of the Federal Gazette, becomes important because his newspaper continues to publish regularly when reliable information is desperately needed. During the epidemic, communication breaks down as officials flee, mail is disrupted, and rumors spread.
Brown’s paper helps fill that gap by keeping public attention on the fever and the city’s condition. His role shows the value of steady information during crisis.
While he is not a doctor or public official, his work supports the city by giving people a source of news when uncertainty is dangerous. Brown represents the press as a civic tool, especially when normal institutions weaken.
Carlos Finlay
Carlos Finlay appears in the later scientific history of yellow fever. His experiments with mosquitoes are significant because they move understanding closer to the truth, even though his peers do not immediately accept his findings.
Finlay’s work shows how scientific discovery can be slow, dismissed, and later proven essential. He is important because he recognizes a connection that people in 1793 could not understand: mosquitoes are central to the spread of the disease.
His character represents persistence in the face of skepticism. Although he does not receive immediate full recognition, his ideas become part of the foundation for later breakthroughs.
Jesse Lazear
Jesse Lazear is one of the most tragic figures in the scientific story of yellow fever. As a doctor working with the U.S. Army’s Yellow Fever Commission, he studies the mosquito theory and becomes convinced that it explains the disease’s spread.
His work places him in direct danger, and he dies of yellow fever before the research is complete. Lazear’s character shows the personal cost of scientific progress.
His death is not only a loss but also part of the evidence that pushes others to take the mosquito connection more seriously. He represents the risks researchers sometimes take when confronting deadly diseases with incomplete protection.
Walter Reed
Walter Reed becomes central to the final understanding of yellow fever’s transmission. As the head of the Army commission, he builds on earlier work and directs experiments that help prove the role of the female Aedes aegypti mosquito.
His importance lies in turning scattered observations and risky experiments into convincing scientific evidence. Reed’s work changes the future of public health because once the method of transmission is understood, prevention becomes more practical.
His character represents the movement from guesswork to evidence-based medicine. Through Reed, the account shows how the lessons of past suffering can lead to lifesaving knowledge.
Themes
Public Health and the Cost of Unpreparedness
Philadelphia’s epidemic shows how quickly a city can collapse when disease meets poor sanitation, weak planning, and limited scientific knowledge. The city is crowded, dirty, and full of standing water, but its residents do not understand how dangerous these conditions are.
Open sewers, rotting waste, polluted water, and mosquitoes create the perfect setting for disaster. Once the fever begins spreading, the city has no clear emergency system ready to respond.
Hospitals are unprepared, public officials flee, and poor residents are left with few options. The crisis exposes the difference between reacting to danger and preparing for it.
Cleaning streets and issuing warnings help, but they come too late and are based on incomplete knowledge. The later improvements to the water system and emergency laws show that suffering can force reform, but the reforms arrive only after thousands have died.
An American Plague makes public health feel like a shared responsibility rather than a private concern. A city’s drains, water, hospitals, housing, and leadership all become matters of survival.
Fear, Rumor, and Social Breakdown
Fear spreads almost as powerfully as the fever itself. As deaths increase, people flee Philadelphia, businesses close, workers disappear, and even basic services become difficult to maintain.
The empty streets and silent houses show how disease changes a city’s emotional atmosphere. Neighbors begin to fear one another.
Travelers from Philadelphia are treated as threats. Mail and newspapers are handled with suspicion.
The sick can become isolated not only by illness but by public terror. Rumor and uncertainty make the situation worse because no one fully understands the cause of the disease or how it spreads.
Doctors disagree, officials send mixed signals, and ordinary people turn to folk remedies, protective smells, tobacco, garlic, or anything that seems to offer safety. The epidemic reveals how fragile social order can be when people feel surrounded by invisible danger.
Yet the same fear that divides people also makes acts of courage more meaningful. Those who stay to nurse, bury, feed, and organize the city act against the strongest instinct of self-preservation.
Race, Service, and Historical Memory
The work of the Free African Society is one of the most important moral centers of the narrative. African American volunteers help care for the sick at a time when many white residents have fled or are too afraid to assist.
Their service is shaped by a painful contradiction: they are asked to save a city that still treats them as unequal. Many are former enslaved people, and slavery still exists in Philadelphia.
The false belief that African Americans are immune to yellow fever places them in danger, and many become sick themselves. Their courage is later met with accusation rather than full gratitude when Matthew Carey criticizes Black nurses in his published account.
The response by Richard Allen and Absalom Jones becomes essential because it challenges a public record shaped by prejudice. This theme shows that history is not only about what happened; it is also about who gets believed afterward.
The epidemic reveals both the generosity of Black civic service and the injustice of a society willing to benefit from that service while questioning its value.
Science, Error, and the Search for Truth
The medical conflict surrounding yellow fever shows science in an unfinished state. Doctors want to explain the disease, but they are trapped between old theories and emerging habits of observation.
Benjamin Rush’s confidence in purging and bloodletting reflects the accepted medical ideas of his era, yet those methods now appear dangerous. Other doctors reject his treatment but do not have a complete answer either.
The disagreement over whether the fever is local or imported shows how difficult truth can be when evidence is limited and fear is intense. The later discoveries about mosquitoes reshape the entire meaning of the epidemic.
What seemed to be caused by bad smells, dirty clothing, or imported air is eventually linked to a specific insect and a specific method of transmission. This theme is not simply about past ignorance.
It shows that knowledge often advances through error, argument, risk, and revision. The movement from Rush’s treatments to Walter Reed’s experiments demonstrates how painful experience can become scientific progress, but only when people are willing to test assumptions and change what they believe.
