to escape "the rod" of god, from which there was no escape. the quaker john todd, who attended the meeting, contracted the fever and died of it. his young widow, dolley payne todd, later married james madison, a virginia congressman whom she met in philadelphia and who later was elected as us president. end of the epidemic president's house, philadelphia. washington left the plague-ridden city for mount vernon on september 10. he and his cabinet reassembled in germantown in early november. on november 11, washington visited the city before the official all clear on november 14, but did not reoccupy the president's house until december. doctors, preachers, and laymen all looked to the coming of autumn to end the epidemic. at first they hoped a seasonal "equinoctial gale," or hurricane, common at that time of year, would blow away the fever. instead, heavy rains in late september seemed to correlate with a higher rate of cases. residents next anticipated freezing temperatures at night, which they knew were associated with ending fall fevers, but not why this was so. by the first two weeks of october, which was the peak of the crisis, gloom pervaded the city. most churches had stopped holding services, and the post office moved out of the area of the highest number of cases. the market days continued, and bakers continued to make and distribute bread. several members of the mayor's committee died. african-american nurses had also begun dying of the fever. carts took ill victims to bush hill and the dead to burial grounds. doctors also became ill and died, and fewer were available to care for patients. three of rush's apprentices and his sister died; he was too sick to leave his house. such news cast doubts on rush's methods, but none of those victims had submitted to his harsh treatment. those refugees from saint-domingue who thought they had immunity used the streets freely, but few other residents did. those who had not escaped the city tried to wait out the epidemic in their homes. when the mayor's committee took a quick census of the dead, they found that the majority of victims were poor people, who died in homes located in the alleys, behind the main streets where most of the business of city was conducted. on october 16, after temperatures cooled, a newspaper reported that "the malignant fever has very considerably abated." stores began to reopen october 25, many families returned, and the wharves were "once more enlivened" as a london-based ship arrived with goods. the mayor's committee advised people outside the city to wait another week or 10 days before returning. in the belief that the epidemic was related to bad air, the committee published directions for cleaning houses which had been closed up, recommending that they be aired for several days with all windows and doors open. "burning of nitre will correct the corrupt air which they may contain. quick lime should be thrown into the privies and the chambers whitewashed." on the 31st, a white flag was hoisted over bush hill with the legend, "no more sick persons here." but, after some warm days, fever cases recurred. the white flag had to be struck. finally on november 13, stagecoaches resumed service to the north and south. a merchant reported that the streets were "in an uproar and rendered the wharves impossible by reason of the vast quantities of wine, sugar, rum, coffee, cotton & c. the porters are quite savvy and demand extravagantly for anything they do." on november 14, the mayor's committee recommended purifying houses, clothing and bedding, but said that anyone could come to the city "without danger from the late prevailing disorder." lists of the dead an official register of deaths listed 4044 people as dying between august 1 and november 9, 1793, based on grave counts, so the total was probably higher. city officials, medical and religious leaders, and newspaper publishers reported the number and names of victims, based on the minutes of the mayor's committee. the appendix of the on-line edition of minutes lists the names of all the patients admitted to bush hill hospital, as well as the disposition of their cases. the publisher mathew carey released his history of the epidemic just weeks after its end. he listed the names of the dead at the back of the book, which is one reason it was a bestseller. cause merchants worried more about rush's theory that the fever arose from the filth of philadelphia and was not imported from the west indies. they did not want the port's reputation to suffer permanently. doctors used his treatments while rejecting his etiology of the disease. others deprecated his therapies, such as dr. devèze, but agreed that the fever had local origins. devèze had arrived on the refugee ship from saint-domingue, which many accused of having carried the disease, but he thought it healthy. the doctors did not understand the origin or transmittal of the disease. differing courses of treatment during the epidemic dr. kuhn advised drinking wine, "at first weaker wines, such as claret and rhenish; if these cannot be had, lisbon or madeira diluted with rich lemonade. the quantity is to be determined by the effects it produces and by the state of debility which prevails, guarding against its occasioning or encreasing the heat, restlessness or delirium." he placed "the greatest dependence for the cure to the disease, on throwing cool water twice a day over the naked body. the patient is to be placed in a large empty tub, and two buckets full of water, of the temperature 75 or 80 degrees fahrenheit's thermometer, according to the state of the atmosphere, are to be thrown on him." the water treatment was also advocated by dr. edward stevens, who in mid-september claimed it had cured alexander hamilton, secretary of the treasury, of the fever. rush 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. (franklin never published the letters.) mitchell noted that the stomach and intestines filled with blood and that these organs had to be emptied at all costs. "on this account," mitchell argued, "an ill-timed scrupulousness about the weakness of the body is of bad consequences in these urging circumstances.... i can affirm that i have given a purge in this case, when the pulse has been so low that it can hardly be felt, and the debility extreme, yet both one and the other have been restored by it." after experimenting, rush decided that a powder of ten grains of calomel (mercury) and ten grains of the cathartic drug jalap (the poisonous root of a mexican plant, ipomoea purga, related to the morning glory, which was dried and powdered before ingesting) would create the desired elimination he was seeking. since the demand for his services was so great, he had his assistants make as many of his powders in pill form as they could. on september 10, he published a guide to treating the fever: "dr. rush's directions for curing and treating the yellow fever", outlining a regimen of self-medication. at the first sign of symptoms, "more especially if those symptoms be accompanied by a redness, or faint yellowness in the eyes, and dull or shooting pains about the region of the liver, take one of the powders in a little sugar and water, every six hours, until they produce four or five large evacuations from the bowels..." he urged that the patient stay in bed and "drink plentifully" of barley or chicken water. then after the "bowels are thoroughly cleaned," it was proper to take 8 to 10 ounces of blood from the arm if, after purging, the pulse was full or tense. to keep the body open he recommended more calomel or small doses of cream of tartar or other salts. if the pulse was weak and low, he recommended camomile or snakeroot as a stimulant, and blisters or blankets soaked in hot vinegar wrapped around the lower limbs. to restore the patient he recommended "gruel, sago, panada, tapioca, tea, coffee, weak chocolate, wine whey, chicken broth, and white meats, according to the weak or active state of the system; the fruits of the season may be eaten with advantage at all times." the sick room should be kept cool and vinegar should be sprinkled around the floor. rush's therapy was generalized as "purge and bleed," and as long as the patient remained debilitated, rush urged further purging and bleeding. not a few of his patients became comatose. the calomel in his pills soon brought on a state of constant salivation, which rush urged patients to attain to assure a cure. a characteristic sign of death was black vomit, which salivation seemed to ward off. since he urged purging at the first sign of fever, other doctors began seeing patients who were in severe abdominal distress. autopsies after their death revealed stomachs destroyed by such purges. unlike other doctors, devèze did not offer advice in the newspapers during the epidemic. he later discussed treatment in his memoir, which included 18 case studies and descriptions of several autopsies. while he deprecated rush's harsh purgatives and "heroic" bleeding, he moderately bled patients and also used medicines to evacuate the bowels. like rush, he thought poisons had to be "abstracted" in severely debilitated patients. instead of purges, he used blisters to raise welts on the skin. unlike kuhn, he did not favor baths. he preferred to apply heat, using hot bricks on hands or feet. he strongly discounted the traditional treatment for severe fevers, which was to wrap patients in blankets, give them camomile tea or madeira, and try to bring on sweats. he preferred "acidulated" water to the use of peruvian bark as many patients found the bark distasteful. he thought the use of opium very helpful. aftermath the governor created a middle path: he ordered the city to be kept clean and the port policed to prevent infected ships, or those from the caribbean, from docking until they had gone through a period of quarantine. the city suffered additional yellow fever epidemics in 1797, 1798, and 1799, which kept the origin and treatment controversies alive. some of the city's clergy suggested the epidemic was a judgment from god. led by the quakers, the religious community petitioned the state legislature to prohibit theatrical presentations in the state. such entertainment had been banned during the revolution and had only recently been authorized. after an extensive debate in the newspapers, the state assembly denied the petition. the recurrences of yellow fever kept discussions about causes, treatment and prevention going until the end of decade. other major ports also had epidemics, beginning with baltimore in 1794, new york in 1795 and 1798, and wilmington and boston in 1798, making yellow fever a national crisis. new york doctors finally admitted that they had had an outbreak of yellow fever in 1791 that killed more than 100 people. all the cities that suffered epidemics continued to grow rapidly. during the epidemic of 1798, benjamin rush commuted daily from a house just outside the city, near what is now 15th and columbia streets, to the new city fever hospital, where as chief doctor he treated fever victims. american doctors did not identify the vector of yellow fever until the late nineteenth century. in 1881 carlos finlay, a cuban doctor, argued that mosquito bites caused yellow fever; he credited rush's published account of the 1793 epidemic for giving him the idea. he said that rush had written: "mosquitoes (the usual attendants of a sickly autumn) were uncommonly numerous..." in the first week of september 1793, dr. william currie published a description of the epidemic and an account of its progress during august. the publisher mathew carey had an account of the epidemic for sale in the third week of october, before the epidemic had ended. the reverends richard allen and absalom jones of the free african society published their own account rebutting carey's attacks; by that time carey had already published the fourth edition of his popular pamphlet. allen and jones noted that some blacks had worked for free, that they had died at the same