ABSTRACT Title of Dissertation: INFECTIOUS DISEASE IN PHILADELPHIA, 1690- 1807: AN ECOLOGICAL PERSPECTIVE Gilda Marie Anroman, Doctor of Philosophy, 2006 Dissertation directed by: Professor Mary Corbin Sies Department of American Studies This dissertation examines the multiple factors that influenced the pattern and distribution of infectious disease in Philadelphia between the years 1690 and 1807, and explores the possible reasons for the astonishingly high level of death from disease throughout the city at this time . What emerges from this study is a complex picture of a city undergoing rapid cultural and epidemiological changes . Large -scale immigration supplied a susceptible population group, as international trade, densely packed street s, unsanitary living conditions, and a stagnant and contaminated water supply combined to create ideal circumstances for the proliferation of both pathogen s and vectors, set ting the stage for the many public health crises that plagued Philadelphia for more than one hundred years. This study uses an ecological perspective to understand how disease worked in Philadelphia . The idea that disease is virtually always a result of the interplay of the environment, the genetic and physical make -up of the individual , and the agent of disease is one of the most importan t cause and effect ideas underpinned by epidemiology. This dissertation integrates me thods from the health sciences, humanities, and social sciences to demonstrate how disease “emergence” in Philadelphia was a dynamic feature of the interrelationships between people and their socio -cultural and physical environments. Classic epidemiological theory , informed by ecological thinking, is used to rev isit the city’s reconstructed demographic data, bills of mortality, selected diaries (notably that of Elizabeth Drinker ), personal letters, contemporary observations and medical literature . The emergence and spread of microbial threats was driven by a complex set of factors, the convergence of which lead to consequences of disease much greater than any single factor might have suggested . Although it has been argued that no precondition of disease was more basic than poverty in eighteenth -century Philadelphia, it is shortsighted to assume that impoverishment was a necessary co - factor in the emergence and spread of disease. The urban environment of Philadelphia contained the epidemiological factors necessary for the growth and propagation of a wide variety of infectious agents, while the social, demographic and behavioral characteristics of the people of the city provided the opportunity for “new” diseases to appear. INFECTIOUS DISEASE IN PHILADELPHIA, 1690-1807: AN ECOLOGICAL PERSPECTIVE by Gilda Marie Anroman Dissertation submi tted to the Faculty of the Graduate School of the University of Maryland, College Park in partial fulfillment of the requirements for the degree of Doctor of Philosophy 2006 Advisory Committee: Professor Mary Corbin Sies, Chair Professor John Caughey Professor Alison Olson Professor Jo Paoletti Professor Robert Sprinkle ©Copyright by Gilda Marie Anroman 2006 DEDICATION To Marianne ii ACKNOWLEDGEMENTS A project the size of a doctoral dissertation cannot be completed alone, and I owe many people a great debt of gratitude for their help in the completion of this one. I would especially like to thank Professor Mary Corbin Sies for her constant support an d guidance in seeing this dissertation through to the end. Any success that I have had as a graduate student I owe largely to her, for she always encouraged me to think critically, to be independent, and to aim for goals beyond those I had set for myself. I would also like to express my sincere thanks to the members of my committee, Professors Robert Sprinkle, Alison Olson, Jo Paoletti and John Caughey, for their comments and review of this dissertation. I would also like to thank Professor Mark Leone fo r his support and encouragement during the early years of my graduate education. A special thanks to my many friends, both on and off the University of Maryland campus. I am especially grateful to Susan Hamadock for introducing me to the study of yoga. My yoga practice facilitated balance in my life in the midst of many challenges. My appreciation also goes to my very dear friends Dr. Dee Shinkle for her personal encouragement and to Michael Hoefler for helping me to understand the words and wisdom of Elizabeth Drinker. iii I would also like to thank the archivists and staff members in those institutions where I carried out most of my research, including the College of Physicians of Philadelphia, the Historical Society of Pennsylvania and the American Phil osophical Society. I have only good memories of working in each of these places and eagerly look forward to future visits. I owe a special debt of gratitude to the College of Physicians for their generous financial support. And last but not least, my greatest debt goes to my friend and companion, Dr. Marianne Walch, without whom this project would never have seen the light of day. It was truly her love and support that gave me the confidence to undertake such a creative challenge. iv TAB LE OF CONTENTS List of Tables………………………………………………………………..vi List of Figures………………………………………………………………vii Chapter 1: Overview and Literature Review…………………………...1 Notes……………………………………………………………….. 47 Chapter 2: Introduction: Dimensions of the Crises……………………. 54 Notes……………………………………………………………….. 80 Chapter 3: Probability of Contact………………………………………85 Notes……………………………………………………………….. 120 Chapter 4: Susceptibility of Host……………………………………… 128 Notes……………………………………………………………….. 155 Chapter 5: Sm allpox, Measles and Yellow Fever: The Consequences of Dense Urban Living ………………... 162 Notes……………………………………………………………….. 211 Chapter 6: Dysentery, Malaria, Tuberculosis, and Typhoid Fever: Omnipresent Menaces ……………………………………... 218 Notes……………………………………………….......................... 262 Chapter 7: Conclusion…………………………………………………. 269 Notes……………………………………………………………….. 280 Bibliography……………………………………………………………….. 282 v LIST OF TABLES Table 2.1 Comparative Crude Death Rates Philadelphia and Boston, 1700-1770………………………………58 Table 2.2 Population Density of Greater Philadelphia, 1790………………...62 Table 2.3 Reconstructed Crude Birth and Death Rates Philadelphia, 1690-1810……………………………….…………..76 Table 2.4 Levels of Confidence………………………………………………80 Table 3.1 Population, Area and Density for Selected United States Cities………………………………………95 vi LIST OF FIGURES Figure 1.1 Plan of the City of Philadelphia, 1800…………………………….11 Figure 2.1 Annual Philadelphia Crude Death Rates, 1690-1994……………..65 Figure 3.1 William Penn’s Plan for Philadelphia, 1683……………………....93 Figure 3.2 Settled Areas of Philadelphia by Ward, 1800……………………..97 Figure 3.3 A Plan of the City of Philadelphia, 1776………………………….100 vii CHAPTER 1 OVERVI EW AND LITERATURE REVIEW This research project began as an attempt to resolve a controversy as to whether yellow fever killed Philadelphians selectively, taking an especially heavy toll among the city’s “lower sort” (as they were labeled by contemporaries )1 during the epidemics of the 1790s. Research into contemporary accounts and observations suggested that it had; death rates were reported to be higher among the urban poor. 2 The demographic data 3 compiled by Susan E. Klepp from bills of mortality, news papers, church records, broadsides and personal papers for the years between 1690 and 1807 hinted at something more significant, however – an astonishingly high level of illness and death from disease throughout the city. These numbers fed my growing hunc h that the historian would do better to explain the prevalence of epidemic and endemic disease in Philadelphia than to reaffirm that the city’s poor were particularly susceptible to disease, especially during times of crisis. Additionally, the Diary of El izabeth Drinker ,4 a rich and detailed source for the history of medicine in the colonial and early national periods from the years 1758 to 1807, revealed that disease was a constant factor in the lives of all Philadelphians – rich and poor alike. 5 Moreover, the medical reports, bills of mortality and 1 demographic data made it clear that the city was a particularly unhealthy place in which to live. 6 This dissertation examines the multiple factors that influenced the pattern and distribution of infec tious disease in Philadelphia between the years 1690 and 1807, and explores the possible reasons for the high level of death from disease throughout the city at this time. What emerges from this study is a complex picture of a city undergoing rapid cultural and epidemiological changes. Large -scale immigration supplied a susceptible population group, as international trade, densely packed streets, unsanitary living conditions, and a stagnant and contaminated water supply combined to create ideal circumstan ces for the proliferation of both pathogens and vectors, setting the stage for the many public health crises that plagued Philadelphia for more than one hundred years. This study breaks with traditional American Studies methodology, and uses an ecologic al perspective to understand how disease worked in Philadelphia. The idea that disease is virtually always a result of the interplay of the environment, the genetic and physical make-up of the individual, and the agent of disease is one of the most import ant cause and effect ideas underpinned by epidemiology. This dissertation integrates methods from the health sciences, humanities, and social sciences to demonstrate