America’s Urban Crisis 1.0: Feuding and Compromise in the Face of an Existential Threat, 1793–1803

Yellow fever devastated Philadelphia four times in the 1790s, killing nearly a quarter of the city’s population. And the nation’s capital and largest city was not alone in its suffering; between 1793 and 1800 yellow fever epidemics struck all major U.S. port cities—most of them several times. Every year, the arrival of hot weather brought a new wave of dread to city residents from Boston to Charleston, many of whom fled at the first sign of danger. Some wondered openly whether urban settlements in the North American climate were simply unsustainable.

Faced with such an existential threat, city leaders scrambled to mount a defense adequate to the task. Nowhere was the risk greater or the stakes higher than in Philadelphia. All agreed that something needed to be done, but a deep divide soon appeared among physicians about the appropriate course of action. One vocal group claimed that yellow fever was brought to this country on ships coming from the West Indies; they advocated a strict maritime quarantine to prevent the disease’s entry. Another equally vocal group insisted that yellow fever arose locally in accumulations of filth after hot, wet weather; they favored an aggressive campaign to clean up public space in the city.

For ten years the two camps feuded bitterly, each unwilling to compromise when the very survival of their city was at stake. The Board of Health that was formed after the 1793 epidemic found itself paralyzed by the heated rhetoric and entrenched mutual distrust. Not until 1803 did a pair of unlikely diplomats engineer a truce. A scheming politician and a prickly, arrogant doctor crafted an appeal to all Philadelphians that bridged the great divide and gave the board a blueprint for protecting public health throughout the nineteenth century.