<P> A 2013 book by Billy G. Smith, professor of history at Montana State University, makes a case that the principal vector of the 1793 plague in Philadelphia (and other Atlantic ports) was the British merchant ship Hankey, which had fled the West African colony of Bolama (an island off West Africa, present day Guinea - Bissau) the previous November, trailing yellow fever at every port of call in the Caribbean and eastern Atlantic seaboard . See: The Ship of Death: The Voyage That Changed the Atlantic World . </P> <P> After two weeks and an increasing number of fever cases, Dr. Benjamin Rush, a doctor's apprentice during the city's 1762 yellow fever epidemic, saw the pattern; he recognized that yellow fever had returned . Rush alerted his colleagues and the government that the city faced an epidemic of "highly contagious, as well as mortal...bilious remitting yellow fever ." Adding to the alarm was that, unlike with most fevers, the principal victims were not the very young or very old . Many of the early deaths were teenagers and heads of families in the dockside areas . Believing that the refugees from Saint - Domingue were carrying the disease, the city imposed a quarantine of two to three weeks on immigrants and their goods, but was unable to enforce it as the epidemic increased its reach . </P> <P> Then the largest city in the US, with around 50,000 residents, Philadelphia was relatively compact and most houses were within seven blocks of its major port on the Delaware River . Docking facilities extended from Southwark south of the city to Kensington to the north . Cases of fever clustered at first around the Arch Street wharf . Rush blamed "some damaged coffee which putrefied on the wharf near Arch Street" for causing the fevers . Soon cases appeared in Kensington . As the port was critical to the state's economy, the Pennsylvania governor, Thomas Mifflin, had responsibility for its health . He asked the port physician, Dr. James Hutchinson, to assess conditions . The doctor found that 67 of about 400 residents near the Arch Street wharf were sick, but only 12 had "malignant fevers ." Alarmed by what Rush and others told him, Mayor Matthew Clarkson asked the city's medical society, the College of Physicians, to meet and advise the city's government and citizens how to proceed . </P> <P> Rush later described some early cases: On August 7, he treated a young man for headaches, fever and vomiting, and on the 15th treated his brother . On the same day a woman he was treating turned yellow . On the 18th a man in the third day of a fever had no pulse, was cold, clammy, and yellow, but he could sit up in his bed . He died a few hours later . On the 19th a woman Rush visited died within hours . Another physician said five persons within sight of her door died . None of those victims was a recent immigrant . </P>

The history of yellow fever in philadelphia 1793