The Testimony Before the College

Seen from above, the city below was a landscape of mud and scaffold, rebuilding in the raw spring of 1794 after the frost that had broken the fever’s hold. Within this setting, the College of Physicians would convene, its institution gathering its fellows as the custodian of medical knowledge for the republic’s capital. Its members had watched the summer of 1793 strip that authority to the bone. Now, from the high windows of Philosophical Hall on Fifth Street, the College meant to reclaim what the epidemic had shattered—not merely the physical infrastructure of care, but the epistemic scaffolding, the right to declare what had happened and why.

The committee room on the second floor had been arranged for the purpose. Chairs set in a semicircle faced a long table where the committee secretary sat with his minutes book. The proceedings were formal. A president presided. Witnesses were called by name, sworn, and examined. The questions were drafted to elicit not narrative but findings: What was the nature of the disease? Was it imported or generated locally? What modes of treatment proved most effective? Behind each question lay a political calculation about what the College could endorse and what it needed to disown.

The first witness to present a sustained body of evidence was the city’s most prominent physician, and also its most controversial. Benjamin Rush, a signer of the Declaration of Independence and a founder of the College of Physicians itself, had spent the months since the epidemic’s end not in retreat but in expansion. His own account of the disease, its causes, and its treatment had already appeared in print. When he appeared before the College’s committee, he brought with him the confidence of a man who believed that the epidemic had vindicated him.

Rush’s testimony was unrepentant. Throughout the crisis, the therapy he advocated was aggressive depletion: copious bloodletting, often to the point of syncope, combined with severe purgation through calomel and jalap. Patients were bled until they fainted. They were purged until they voided. The disease, in Rush’s reasoning, was a form of “morbid excitement” in the vascular system, and the physician’s task was to reduce that excitement by whatever means the body could endure. In his published writings, Rush compared the disease to a fire in a house: the only rational response was to remove the fuel, and the fuel was the blood itself.

Before the committee, Rush laid out his case with systematic clarity. Hundreds of patients had passed through his care. As the epidemic progressed, his methods were refined—increasing the quantity of blood drawn as he became convinced that milder interventions were useless. Case notes, mortality figures, and reasoning were presented. He did not hedge. The treatment had worked. The proof was in the patients who had survived.

What Rush understood, and what the College understood, was that the question was not merely medical. The therapy a physician chose in 1793 had become a political statement. To defend Rush’s methods was to defend the most aggressive, most visible response to the crisis. To reject them was to reject the man who had been, for many Philadelphians, the face of the medical response. Rush had signed the Declaration of Independence. He had served the Continental Congress. He was a professor at the University of Pennsylvania. The College could not simply rule against him without ruling against a founding father.

But the College had also heard from other witnesses, and other traditions of practice. The most significant alternative voice was that of the French physician Jean Devèze, who had served as the chief medical attendant at the Bush Hill hospital. Devèze had arrived at Bush Hill in September 1793, when the hospital was barely functional. Wards were overflowing. Staff had fled. He reorganized the facility and instituted a regimen of care that was, in every particular, the opposite of Rush’s.

Devèze did not bleed. He did not purge. Cooling drinks, light nourishment, rest, and what he called “supportive” measures formed the core of his approach. Case notes kept at Bush Hill told a different story than Rush’s. Devèze’s patients had been the poorest, the most abandoned, the most advanced in their illness when they arrived. Yet among those who could still respond, his methods had produced recoveries that he attributed not to depletion but to sustenance. Where Rush had subtracted, Devèze had added. Where Rush had attacked the disease, Devèze had fortified the patient.

The contrast was not lost on the committee. Nor was the political subtext. Devèze was a Frenchman, a foreign practitioner whose presence in Philadelphia was itself a product of the Atlantic revolutions that had deposited refugees from Saint-Domingue and France into the city’s streets. His methods drew from a European tradition of skepticism toward heroic intervention. Yet his results at Bush Hill had been observed by the Committee of Twenty, by Mayor Clarkson, by the merchant Stephen Girard who had volunteered alongside him. These were credible witnesses. Their testimony could not be dismissed.

The College found itself in a difficult position. Its own fellows had been divided during the epidemic. Some had endorsed Rush’s methods. Others had dissented. The College had issued public statements during the crisis, including a recommendation that the city be cleaned, but it had not formally adjudicated the dispute between depletion and support. That dispute had played out in the newspapers, in pamphlets, in private letters, and at the bedside, where the choice of therapy often depended on which physician arrived first.

Now the College meant to settle the matter, or at least to produce a document that would frame it for the future. The committee’s inquiry was structured as a causal investigation: what caused the epidemic, what propagated it, what treatments were justified by the evidence. Each question opened onto the next. If the disease was imported, then the city’s quarantine regulations were at fault. If it was generated locally, then the city’s sanitation was to blame. If Rush’s depletion was correct, then the physicians who had opposed it had committed malpractice. If Devèze’s supportive care was correct, then Rush had killed patients. These were not abstract questions. They were questions of professional survival.

The committee heard from other physicians as well. Philip Syng Physick, who had assisted at Bush Hill and observed both methods in practice, presented his observations. Physick was young, trained in London, and had served as an apprentice to Rush before developing his own independent judgment. His testimony carried weight because he had been present at the bedside of patients treated under both regimens. What he reported was nuanced: that some patients had survived Rush’s bleeding, and some had survived Devèze’s care, and that the determining factor in most cases had been the stage of the disease at which treatment began, not the method employed. This was not what either Rush or Devèze wanted to hear.

The committee also received written testimony from physicians who had fled the city and treated patients in the surrounding countryside. Their accounts varied. Some had employed depletion with success. Others had tried it, observed disastrous results, and abandoned it. The evidence was contradictory, as evidence in medicine tends to be. What the committee made of it would depend less on the data than on the frame into which it was placed.

That frame was the College’s own institutional interest. The epidemic had exposed the fragility of medical authority in a republic that distrusted expertise. When the crisis struck, physicians had disagreed publicly, violently, and in terms that laypeople could understand. The newspapers had printed the arguments. Patients had chosen their physicians on the basis of political affiliation, personal loyalty, or sheer desperation. The notion that medicine was a science governed by trained professionals had taken a severe blow. The College’s inquiry was, among other things, an effort to repair that damage. If the College could produce a consensus document, a published set of findings that physicians could point to as authoritative, then the profession’s claim to specialized knowledge would be reasserted.

This was the deeper question the committee faced. Not merely what had caused the epidemic, or what had cured it, but who had the right to say so. The sovereignty of care—the authority to define what constituted proper treatment—had been contested at every level during the crisis. Rush had claimed it through his theory and his willingness to act on it. Devèze had claimed it through his results at Bush Hill. The Committee of Twenty had claimed it through civic administration. The Free African Society had claimed it through the labor of its nurses and carters, the Black Philadelphians who had answered Benjamin Rush’s appeal and served where white nurses would not. Each of these claims was now, in the spring of 1794, being adjudicated, sorted, and ranked.

The College’s proceedings were conducted behind closed doors, but their results would be published. The document that emerged was titled, with the characteristic specificity of eighteenth-century scientific literature, An Account of the Causes and Effects of the Epidemic Disease which Raged in Philadelphia. It appeared in 1794, the same year that the Mayor’s Committee published its own minutes. These two publications—the medical inquiry and the civic record—constituted the first official histories of the epidemic. Together, they would shape the understanding of what had happened for generations.

What the College’s account included was a careful synthesis. It acknowledged that the disease had likely been imported, a conclusion that shifted responsibility away from the city’s permanent conditions and toward the contingency of a single infected vessel. It endorsed, in measured terms, the value of sanitary improvements. It discussed the question of treatment with a deliberateness that suggested the committee had examined the evidence and reached a considered judgment. What it did not do was condemn Rush. It also did not endorse him. The treatment question was handled with a studied ambiguity that allowed both sides to claim vindication while denying either side the satisfaction of a clear verdict.

This was narrative triage. The College was sorting the competing accounts of the epidemic—Rush’s, Devèze’s, the newspaper reports, the pamphlets—and producing a single, authorized version. In that version, the medical profession had responded to the crisis with reasonable differences of opinion. The most extreme practices were softened in the retelling. The disagreements among physicians were presented as a legitimate range of professional judgment rather than a scandalous public disarray. The epidemic became, in the College’s account, a test that the profession had weathered, not a catastrophe that it had compounded.

What was omitted or minimized was equally significant. The scale of the mortality—the roughly five thousand dead, a tenth of the city’s population—was acknowledged but not dwelt upon. The racial politics of the crisis, the fact that Black nurses and carters had been recruited on the false premise that they were immune to the disease, received no sustained attention in the medical proceedings. The College’s inquiry was about physicians and their methods, not about the laborers who had carried the bodies.

Richard Allen and Absalom Jones had organized free black Philadelphians as essential workers during the epidemic, answering Rush’s direct appeal. They had served as nurses and carters. They had buried the dead. And in the months after the crisis, they had published their own account—a reply to Mathew Carey’s widely circulated pamphlet, which had accused Black workers of extortion and theft during the epidemic. Allen and Jones’s narrative, published in 1794, was itself a form of testimony. It documented what they had done, what they had been promised, and what they had not received. It was a counter-history, and it existed outside the College’s proceedings entirely. The medical inquiry did not call them as witnesses. The institutional mechanisms of truth-making in 1794 were not designed to hear them.

The College’s published proceedings thus became the canonical medical account of the epidemic, and the omissions within it became the silences that later historians would have to excavate. The document codified a version of events in which physicians had debated, had disagreed, and had ultimately learned from the crisis. It was a version that served the profession’s interests. It restored the authority that had been lost. It positioned the College as the arbiter of medical truth, the body to which future legislators and civic leaders would turn when the next epidemic came.

But in the spring and summer of 1794, the College was engaged in something more immediate than long-term planning. It was engaged in the work of converting chaos into narrative. The raw material of the epidemic—the screams from the sickrooms, the carts rolling through empty streets, the bodies stacked in churchyards, the flight of the federal government, the collapse of municipal authority—had to be processed into a form that the profession and the city could use. Not to understand it fully. Not to confront every dimension of its horror. But to contain it. To make it manageable. To make it a chapter in the history of medicine rather than a wound in the body of the republic.

The College’s proceedings were, in this sense, an act of professional self-preservation disguised as scientific inquiry. The distinction between those two things was, in 1794, barely visible. The College believed that what was good for the profession was good for the public. If physicians were discredited, who would treat the sick? If the College’s authority was not restored, who would coordinate the response to the next crisis? The institutional interest and the public interest were, from the College’s vantage point, identical.

The testimony of Rush and Devèze, preserved in the committee’s minutes and summarized in the published account, represented two visions of what medicine should be in the new republic. Rush’s vision was heroic, interventionist, and democratic in its implications: any physician, armed with a lancet and a vial of calomel, could treat the disease. This was a medicine of action, of conviction, of the physician as combatant. Devèze’s vision was cautious, supportive, and elite in its assumptions: the physician’s skill lay in judgment, in knowing when to act and when to refrain. This was a medicine of restraint, of expertise, of the physician as steward.

The College could not fully embrace either vision. To embrace Rush was to own the excesses of depletion, the patients bled to death in the name of theory. To embrace Devèze was to concede that the most prominent American physician in the republic’s capital had been wrong, catastrophically wrong, and that a foreigner had been right. The committee’s solution was to decline to choose. Its published account presented both methods as having merit under different circumstances. It praised both physicians for their service. It declined to render a definitive judgment on the central therapeutic question.

This was, in institutional terms, the correct decision. It preserved the College’s unity. It avoided a public schism among the city’s leading physicians. But it was also a decision that deferred the most important question. If the College would not say which method was right, then what had it learned? If the inquiry could not distinguish between the physician who bled and the physician who did not, then what authority did it claim to adjudicate the next dispute?

The answer the College gave, implicitly, was that its authority lay not in its conclusions but in its process. The fact that the inquiry had been conducted, that testimony had been taken, that a document had been published—this was what mattered. The College had demonstrated that it could convene, examine, and pronounce. The specific content of the pronouncement was secondary to the act of pronouncing. In a republic that valued procedure, the College’s proceedings were themselves a claim to institutional legitimacy. The inquiry was the verdict.

The Mayor’s Committee, publishing its own minutes in March 1794, had performed a similar function on the civic side. Its record documented the decisions made during the crisis: the appointment of managers, the establishment of hospitals, the procurement of supplies. It was a ledger of governance under extreme conditions, and it served to legitimate the Committee of Twenty’s assumption of authority during the collapse of the regular municipal government. Like the College’s proceedings, it converted improvisation into policy, emergency measures into precedent. Together, the two documents established the official memory of the epidemic.

Against these official accounts stood the unofficial ones. Helmuth’s diary, kept by the Lutheran minister J. Henry C. Helmuth through the worst weeks of the crisis, recorded details that the official proceedings smoothed over: the terror in the streets, the collapse of social bonds, the desperation of the poor. And there were the accounts by Allen and Jones, which contested the official memory on the question of Black labor and its value. And there was Mathew Carey’s pamphlet, already in its fourth edition by early 1794, which had shaped public understanding of the crisis more powerfully than any official document.

The College’s proceedings entered this crowded field of competing narratives with the authority of institutional science. The College was not a newspaper. It was not a pamphleteer. It was the recognized body of medical expertise in the capital of the republic, and when it spoke, it spoke with the weight of professional consensus, or at least with the appearance of it. Its published account would be cited in medical journals, in legislative debates, in future histories. It would become the reference point to which later writers turned when they wanted to know what the physicians had concluded.

This was the College’s achievement, and its cost. By conducting the inquiry and publishing its results, the College established the medical narrative of the epidemic as a professional document, governed by professional standards, answering professional questions. The epidemic became, in this rendering, a medical event: a disease with a cause, a course, and a treatment, examined by qualified men and reported in qualified terms. The political dimensions—the flight of the federal government, the racial exploitation of Black labor, the market failures and price gouging—were present but peripheral. The center of the story was the physician and his method.

This framing had consequences that extended far beyond 1794. It established the template for how future epidemics would be understood and debated in the United States. The medical narrative would take precedence over the social and political narrative. The question of what the physician did would take precedence over the question of what the society did, or failed to do. The College’s proceedings were not merely a document about the 1793 epidemic. They were a blueprint for the institutional memory of public health crises in America.

The irony was that the College’s inquiry, intended to settle the controversies of the summer, ultimately demonstrated that they could not be settled. Rush continued to defend his methods. Devèze continued to advocate for his. The published account’s careful ambiguity satisfied neither man. Rush, in particular, was not a man who accepted ambiguity. His own account had appeared before the College’s proceedings, and defenses of bloodletting would continue to flow from his pen for years, refining his arguments, insisting that the epidemic had proven his theory correct. The College’s refusal to endorse him fully was, in his view, a failure of nerve, not a failure of evidence.

The dispute between Rush and the College was, at its core, a dispute about who controlled the narrative. Rush believed that the physician who had treated the most patients, who had stayed in the city when others fled, had the right to pronounce on what had happened. The College believed that the institution, not the individual, held that right. Rush’s testimony before the committee was a challenge to the College’s authority as much as a defense of his methods. He was saying: I was there. I know what I did. No committee can tell me otherwise.

The College’s response, in its published proceedings, was equally clear. The individual physician’s experience was valuable, but it was not dispositive. The institution would weigh it against other evidence, other testimony. The College would decide what the evidence meant. This was the assertion of a particular kind of authority: not the authority of the hero, not the authority of the witness, but the authority of the body, the collective, the institution that could survey the whole field and render a judgment that no single participant could render.

It was an assertion that would have been familiar to the framers of the republic, who had spent the preceding decade constructing institutions designed to contain individual ambition and channel it toward collective purposes. The College of Physicians was, in its own small way, participating in the same project. It was building the institutional infrastructure of a profession that would, in the coming century, become one of the most powerful forces in American life. The epidemic of 1793 had shown how fragile that infrastructure was. The inquiry of 1794 was an attempt to make it less so.

The testimony was complete. The committee had heard from Rush, from Devèze, from Physick, from the physicians who had served in the city and in the countryside. The minutes were transcribed, the findings compiled, the account drafted and sent to the printer. What emerged was a document that looked like science and functioned like politics. It was the official story, or at least the official medical story, and it would stand for years as the version of events that physicians and legislators and historians would consult when they wanted to know what had happened in Philadelphia in the summer of 1793.

The College had convened. The testimony had been given. The document had been published. And the epidemic of 1793 had become, in the official memory of the American medical profession, a managed event: examined by qualified men, reported in qualified terms, and stripped of the chaos and contention that had made it, for those who lived through it, something closer to a reckoning. The proceedings lay on desks and in archives, their pages carrying the weight of institutional authority. But outside the College’s chamber, in the newspapers and pamphlets and churchyards where the epidemic’s survivors still gathered, the argument over what had happened, who was to blame, and who deserved credit was only beginning.