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SUMMARY: In the Autumn of 1780 an epidemic hit the city of Philadelphia. The symptoms of the disease resembled those of present day dengue fever, and subsequent observers argued that the disease was in fact dengue. But was it? The question forces us to confront the challenges of retrospective epidemiology and how we examine the history of a disease. This paper examines the 1780 epidemic from two perspectives. First, it looks at evidence that the disease was dengue and examines what this tells us about the epidemic and the conditions that caused it. Second, it looks at the disease from the perspective of Dr. Benjamin Rush, who treated hundreds of patients during the epidemic. In other words, it examines the disease through the lens of eighteenth century medical ideas. The paper concludes that each approach is valuable and reveals different aspects of the relationship between society and disease.
KEYWORDS: breakbone fever, dengue, Benjamin Rush, Philadelphia, epidemics
The summer of 1780 was filled with promise for the residents of Philadelphia. While July and August were unusually hot and punctuated by the usual outbreaks of fever and dysentery, along with disturbing reports from the war, the British occupation of the city had ended and the naval blockade of the Delaware River and Chesapeake Bay had been broken. Merchant ships were slowly returning to the port of Philadelphia. While the war continued, it had moved south. These events, combined with the expectation of an exceptionally good wheat harvest in the Delaware Valley, signaled the return of better times.1
On the 19th of August, however, the air turned suddenly cool. The next day an epidemic broke out among the city's residents. Dr. Benjamin Rush, who provided a detailed account of the outbreak, claimed that scarcely a family, and in many families, scarcely a member of them, escaped it.2 The diaries and letters of other city residents confirm Rush's observation. Rush identified the disease as a true "bilious remitting fever."3
He observed that the fever remitted every morning and sometimes in the evening and that the exacerbations of the disease were worse every other day, with two exacerbations observed in one day. Many patients also developed a rash in the third or fourth day. The rash was accompanied...