The Dispute Over the French Method

On a morning in early October 1793, in a house on the south side of Walnut Street, a physician opened a vein and watched between four and six ounces of blood flow from a patient whose skin had already turned the color of parchment. The same morning, at Bush Hill, a French doctor instructed a nurse to bring barley water to a woman in the third ward and to let no one disturb her rest. The two orders traveled through the same city, through the same epidemic, and into the same bodies. They asked opposite things of the sick.

Benjamin Rush believed the body was a single system. Every disease, in his understanding, reduced to the same fundamental fault: an excess of excitement in the blood vessels, a morbid tension that could only be relieved by subtraction. Bleeding drained the excess. Purging expelled it. Calomel, a mercury compound, and jalap, from the root of a Mexican plant, were his instruments, administered in combination and in quantities that modern readers would find alarming. He had arrived at this position through years of practice, reading, and a conviction that medicine must operate by universal principles. The epidemic gave him the stage to test that conviction at scale.

Jean Devèze believed no such thing. A French physician who had served in Saint-Domingue before the revolution drove him to Philadelphia, Devèze had observed yellow fever in the Caribbean, where it was endemic. He had watched patients survive and die under different regimens. What he concluded was that the disease imposed a weakness, a collapse of the body’s tone, and that aggressive intervention only deepened the collapse. His prescription was rest, mild fluids, cool air, and small quantities of wine as a stimulant. He did not bleed. He did not purge. He let the body find its way back to function, supporting it with what nourishment it could accept.

The two men disagreed about what a physician was.

Rush wrote letters. Throughout September and October, in notes pressed flat by urgency and exhaustion, he described his regimen to colleagues, defended it against critics, and refined its dosages.

He was a man who believed that the correctness of a theory could be established by its logic, and that observation must conform to principle or be discarded as anomalous. He had searched the medical literature for other approaches. Benjamin Franklin had given him letters sent by Dr. John Mitchell, related to treating patients during a 1741 yellow fever outbreak in Virginia. Mitchell noted that the stomach and intestines filled with blood and that these organs had to be emptied at all costs. Rush had tried the stimulating remedies advocated by Dr. Edward Stevens, who in mid-September claimed the treatment had cured Alexander Hamilton, the Secretary of the Treasury.

Rush claimed that his patients still died. Stimulation, he concluded, fed the fever rather than quenching it. It was dangerous. He returned to depletion with greater conviction.

Devèze wrote later, after the epidemic, with the composure of a man who had been tested and found his method sound. His account described a hospital at Bush Hill where patients were given water, air, and patience. He had taken charge of the medical care at the estate after Stephen Girard established the logistical order that kept the place functioning. Where Rush saw a universal principle to be enforced, Devèze saw particular bodies to be observed. He adjusted his treatment to the patient, not the patient to the treatment.

The contrast was not abstract. It played out in the wards of Bush Hill, where patients lay on cots set close together in the converted mansion’s rooms and hallways. The hospital had been improvised from an abandoned estate. It had no tradition, no established protocol, no inherited authority. Its medical direction was whatever the physician on duty said it was. And the physicians on duty did not agree.

Nurses recruited by the Free African Society moved among the beds. They carried out orders from both doctors, sometimes in the same shift, sometimes for the same patient. Richard Allen and Absalom Jones had organized the Black volunteers who served as nurses and gravediggers, responding to an appeal from Rush himself, who believed they were immune to the fever. The appeal rested on a false premise. Black Philadelphians were not immune. They sickened and died at rates that would become clear only after the epidemic passed. But in October, they were the labor force that kept Bush Hill operating, and they were the witnesses to a dispute that the physicians themselves could not resolve.

A patient admitted under Rush’s protocol might be bled within the first hour, given a dose of calomel and jalap, and bled again if the fever did not break. The same patient, transferred to a ward under Devèze’s direction, might be given barley water, a small cup of wine diluted with water, and silence. The nurses saw what happened next. Some patients survived under both regimens. Some died under both. The epidemic’s mortality rate was high enough that no method could claim unambiguous success, and the evidence confounded everyone at the bedside. What mattered was not only what the doctors did but what they believed they were doing, and what they claimed about it afterward.

Rush’s position had the force of authority behind it. He was Philadelphia’s most prominent physician, a signer of the Declaration of Independence, a professor at the University of Pennsylvania, and a man whose connections reached into the highest levels of the federal government that had fled the city. His word carried weight. When he declared that bleeding and purging were the correct treatment, he said it with the confidence of a man who believed he had derived his conclusions from first principles. He was not guessing. He was reasoning, and his reasoning led him to a regimen that he applied without hesitation.

Devèze’s position had the force of observation behind it. He had seen yellow fever before. He knew what it did to the body, and he had watched the body recover when it was given the chance. He did not claim to understand the disease’s origin or its mechanism of transmission. He claimed only to know what helped and what harmed, and he believed that bleeding and purging harmed. His method was not a theory. It was a practice, refined through repetition in a place where yellow fever was a familiar enemy.

The conflict between them was a contest for authority in a city that had lost all its other authorities.

The federal government was gone. President Washington had left in early September. The Treasury, the War Office, the State Department, the courts, the legislature, all had departed or ceased to function. The mayor, Matthew Clarkson, and the Committee of Twenty were the residual civic authority, and they were administrators, not physicians. They managed supplies, coordinated burials, maintained order, and kept the hospital running. They did not dictate medical practice. In the absence of any institution with the power to adjudicate the dispute, the decision about how to treat the sick fell to whoever was standing at the bedside.

This was the sovereignty of care, openly disputed. Two physicians, two methods, no arbiter. The Committee could fund Bush Hill, supply it with food and medicine, and send it patients, but it could not resolve the question of whether a patient should be bled or given wine. That question belonged to the doctors, and the doctors answered it differently.

The dispute escalated through October. Rush, writing to colleagues, defended his method with increasing stridency. He had staked his professional reputation on the correctness of depletion. If he was wrong, the implications were not merely clinical. They were moral. Every patient he had bled, every purge he had administered, would become not a treatment but an injury. He could not accept that possibility. He argued that patients who died under his care had been treated too late, or had been given stimulating remedies by other physicians before he arrived, or had been weakened by factors outside his control. The theory was sound. The failures were exceptions.

Devèze, in his later account, described what he saw without Rush’s need for theoretical coherence. The color of the patients’ skin, the frequency of the pulse, what they could drink and what they could not—these were the facts that guided his hand. Cool air and quiet were his prescriptions. Wine in small quantities was his stimulant. He watched. His account reads like a man who understood that he was treating a disease he could not cure, and that his role was to keep the body alive long enough for the disease to run its course.

The difference was philosophical. Rush believed the physician’s role was to act, to intervene, to correct the body’s derangement by force. Devèze believed the physician’s role was to support, to sustain, to give the body what it needed to correct itself. The first approach demanded confidence. The second demanded patience. In the wards of Bush Hill, both were present, and the patients had no way to choose between them.

The nurses saw the results. They carried the barley water. They held the basins for the blood. They changed the sheets and turned the patients and carried the dead to the carts. Patients survived under Devèze’s care and died under Rush’s, or survived under Rush’s and died under Devèze’s, and the nurses had no framework for interpreting what they saw. They were not physicians. They were workers, performing the physical labor of care, and their testimony, when it came, would be delivered not in medical journals but in a pamphlet that answered the accounts published by white Philadelphians who had criticized their conduct.

The epidemic did not resolve the dispute. It intensified it. As the death toll mounted, each side looked at the same catastrophe and drew opposite conclusions. Rush saw evidence that his method was correct and that it had not been applied aggressively enough. Devèze saw evidence that depletion was killing patients who might otherwise have survived. The data were ambiguous. The mortality rate was high under every regimen. No one could say with certainty whether any given patient had lived or died because of the treatment or in spite of it.

This was the intellectual crisis at the heart of the epidemic. The city was not only losing its people. It was losing its ability to agree on what was happening to them. The dispute between Rush and Devèze was a dispute about the nature of evidence, the authority of theory, and the proper relationship between a physician and a patient’s body. It was, in miniature, the same crisis that had paralyzed the city’s civil institutions: when the scale of the disaster exceeded the capacity of existing frameworks to explain it, the result was not consensus but fragmentation.

Rush wrote to colleagues in other cities. He published his theories. He insisted that his method was the American method, that it was derived from principles applicable to all diseases in all bodies, and that the French approach was not merely different but wrong. He framed the dispute as a contest between a native tradition of rational, aggressive medicine and a foreign practice of timid palliation. The nationalism was not accidental. In a city stripped of its federal institutions, the language of national identity became a proxy for professional authority. To call a method American was to claim it for the republic, and to call a method French was to mark it as alien.

Devèze did not answer in kind. His account was clinical, not polemical. He described what he did and what he observed. He did not name Rush. He did not engage the theoretical dispute. He simply reported that his patients at Bush Hill, treated with rest and fluids and mild stimulants, recovered at a rate that satisfied him. The silence was its own argument. In a city where Rush was publishing furiously, Devèze’s restraint read as confidence.

The Committee of Twenty watched from the margins. Its minutes, which would be published in March 1794, recorded the logistics of Bush Hill: the supplies purchased, the staff hired, the patients admitted and discharged. They did not record the medical dispute. The Committee’s authority was administrative. It could keep the hospital open, but it could not tell the doctors how to doctor. Other yellow fever outbreaks would strike Philadelphia and cities across the northeastern United States in the years that followed, and each would generate fresh narratives of containment, treatment, and endurance. Rush wrote accounts of his own. Devèze wrote his. The Committee wrote its minutes. Each document told a different story about the same catastrophe.

The disagreement was not confined to Rush and Devèze. Other physicians had taken positions. Dr. Edward Stevens had advocated the stimulating method, the water treatment, and had claimed it cured Hamilton. Dr. Adam Kuhn had recommended a different set of remedies. Rush had tried their approaches and rejected them. He claimed that his patients still died under stimulating regimens. The medical community of Philadelphia, diminished by flight but still active, had fractured into rival factions, each certain its own approach was the sole legitimate practice and quick to call the others dangerous quackery.

The clergy added another layer. The Lutheran minister J. Henry C. Helmuth and others framed the epidemic as divine judgment, a punishment for the city’s sins. This narrative triage, the process of assigning cause and blame to control the moral outcome of the catastrophe, competed with the physicians’ clinical explanations. If the fever was God’s will, then the question of whether to bleed or to give barley water was secondary. The clergy’s framing did not resolve the medical dispute. It added a third position: that the cause was moral, not physical, and that the treatment was repentance, not medicine.

The patient at the center of this was irrelevant to the dispute. The sick man or woman on the cot at Bush Hill did not care whether the theory that governed their treatment was American or French, rationalist or empiricist, depletionist or stimulationist. They cared whether they lived. And the physicians, in their different ways, cared too. Rush bled aggressively because he believed it saved lives. Devèze prescribed barley water because he believed it saved lives. The sincerity of both men was not in question. The consequences of their sincerity were.

By early October, the dispute had reached the point where patients and their families were making choices based on which doctor they trusted. Rush was the choice of those who believed in aggressive intervention. Devèze was the choice of those who did not. And some families wanted no doctor at all, preferring to treat themselves with whatever remedies neighbors recommended, which ranged from vinegar and cold water to camphor and gunpowder. The absence of a medical consensus had created a market of competing treatments, and in a city where the institutions that might have enforced a standard had collapsed, the market was the only authority left.

The crisis at Bush Hill was not that two doctors disagreed. It was that the disagreement could not be resolved by any mechanism the city still possessed. The College of Physicians had effectively ceased to function. The University of Pennsylvania’s medical school was scattered. The federal government, which might have convened an inquiry or appointed a committee, was in Germantown or farther. The mayor and the Committee were consumed with logistics. In this vacuum, the dispute between Rush and Devèze became a contest not only between methods but between the foundations on which medical authority rested.

Rush’s authority was institutional and intellectual. He held a professorship. He had written extensively. His political connections gave him a platform that no other physician in the city could match. When he spoke, people listened, not because he was necessarily right but because he was Benjamin Rush. His method, whatever its merits, carried the weight of his position.

Devèze’s authority was experiential and institutional in a different way. He had the authority of Bush Hill. He was the physician on site, the man who saw the patients every day, who adjusted his treatments based on what he observed, and who had the support of Stephen Girard, the merchant who had taken over the hospital’s management and who trusted the French doctor’s judgment. Girard was not a physician, but he was the man who kept the hospital running, and his confidence in Devèze gave the French method a practical authority that Rush’s theoretical authority could not easily override.

The result was a standoff. Rush could publish. He could write letters. He could argue. But he could not walk into Bush Hill and take control. The hospital was Girard’s domain, and Girard had chosen Devèze. Rush’s method would continue in the homes and private practices where he held authority, and Devèze’s method would continue at Bush Hill, and the two streams would flow side by side through the same epidemic without converging.

The frost came late in October. The mosquitoes that carried the virus, though no one in Philadelphia knew they existed, began to die as the temperature dropped. The epidemic slowed. The death rate fell. Patients who had been lingering began to recover, regardless of which method had been applied to them. The crisis passed, and the dispute did not.

In the weeks after the epidemic, the argument intensified. Rush published his account, defending his method and attributing the city’s survival to the correctness of depletion. Devèze published his, describing the results at Bush Hill with quiet satisfaction. The Committee published its minutes. Mathew Carey published his account, and then a fourth edition. Allen and Jones published their reply, the Narrative of the Proceedings of the Black People, which confronted accounts of the epidemic that had censured their community’s conduct. Each publication was a claim on the truth of what had happened. Each was an attempt to shape the story of the catastrophe into a form that served the teller’s understanding of what had occurred.

The medical dispute did not end with the frost. It hardened into a permanent fracture in American medicine. Rush’s defenders and Devèze’s defenders would argue for years about which method had been correct, and the argument would be revived with each new outbreak of yellow fever in the decades that followed. The question of whether to bleed or to nourish, to deplete or to support, would outlast every patient who had been bled or nourished in the wards of Bush Hill.

What remained, in the immediate aftermath, was a city that had been fragmented not only by death and flight but by the inability of its leading minds to agree on what had killed its people and what, if anything, had saved them. The dispute between Rush and Devèze was the epidemic’s intellectual crisis, the moment when the machinery of interpretation broke down under the weight of the event it was supposed to explain. The physicians had done their best. Their best had not agreed. And the sick, in the wards of a converted mansion on a hill outside the city, had been the subjects of an experiment that no one had designed and no one could conclude.

The nurses who had carried the barley water and held the basins for the blood went home. Some of them were sick. Some of them would die in the weeks that followed, their own bodies yielding to a disease that the physicians had said they could not catch. The Free African Society had given its labor to the care of the sick and the burial of the dead, and the question of what it was owed, for that labor and for the lives it had cost, was about to be asked.