When I decided to leave Philadelphia earlier than planned from my research trip to the F.C. Wood Historical Medical Library, I was reading the founding documents of the College of Physicians of Philadelphia, from 1793. The CPP is the longest standing settler-colonist medical institution on the continent. Benjamin Rush founded it, wanting a place for young men to come get trained in the art of physics—and of course, Benjamin Rush was also one of the signatories on the Declaration of Independence, so his name and the institution hold a coveted space in the settler narrative of this nation’s founding. In late August of 1793, the College of Physicians was asked to provide recommendations for what we now know as “public health” during a yellow fever outbreak in Philadelphia. This outbreak ended up lasting until 1795. I was reading this document as the staff and administration of the College of Physicians and its’ sub-institutions, the Mutter Museum and the F.C. Wood Historical Medical Library, were having an all-staff meeting to announce the closure, for two weeks, of most functions of the institution, in the early stages of the coronavirus pandemic in North America. The experience was surreal, to say the least.
I want to write about this, and share it with you because as I was reading, I was thinking about the way that health, disease, fear, and love bind us all together, across space and time. As fear spreads virally across our social media even faster than the exponential curve of infection’s outbreak across our communities, I also see love, and calls for community care, iterating outwards. The fact that I, like so many of us, chose to go home, and to minimize my contact with other people as much as possible, is not just because I live with chronic illness—it’s because each of us, each body, each heart we carry around, has a chance to be in loving community, even in a time of fear and mortality, by pausing, and resting, and reimagining what the world can look like.
So now I’ll tell you the story about the College of Physician’s response to yellow fever. You can see a couple of images of the handwriting and the document here. Two things in particular stood out to me. First, the way that understandings of what a disease is, and how it is communicated, have changed over time. Lots of folks have written about this elsewhere, but I’ll add my two cents as well. And second, I was deeply struck by recommendations the Fifth, and the Eighth, from the College of Physicians’ list.
Here’s a transcript of the College’s earliest recommendations in full:
August 26th 1793.
The [College of Physicians Committee on Fever] reported a Copy of Directions for preventing the further progress of the malignant Fever, which being amended was agreed upon. It was agreed to have it signed by the Vice President and Secretary, and to send a Copy of it to the Mayor. The directions were as follows, viz.
The College of Physicians having taken into consideration the malignant and contagious Fever which now prevails in this City, have agreed to recommend to their Fellow Citizens the following means of preventing its progress.
First. That all unnecessary intercourse should be avoided with such persons are infected by it.
Second. To place a mark upon the door or window of such houses as have any infected persons in them.
Third. To place the persons infected in the Centre of Large and Airy Rooms, in Beds without Curtains, and to pay the strictest regard to cleanliness by frequently changing their Body, and Bed Linen; also by removing as speedily as possible all offensive matters from their Rooms.
Fourth. To provide a large and airy hospital in the neighborhood of the City, for the reception of such poor persons as cannot be accommodated with the above advantages in Private houses.
Fifth. To put a stop to the tolling of the Bells.
Sixth. To bury such persons as die of the fever in carriages, and in as private a manner as possible.
Seventh. To keep the streets and wharves of the city as clean as possible—As the Contagion of the Disease may be taken into the Body, and pass out of it without producing the Fever, unless it be rendered active by some occasional Cause, the following means should be attended to prevent the Contagion from being excited into Action in the Body.
Eighth. To avoid all Fatigue of Body and Mind.
Ninth. To avoid standing or sitting in the Sun, also in a Current of Air, or in the evening air.
Tenth. To accommodate the dress to the Weather, and to exceed rather in warm than in cold clothing.
Eleventh. To avoid Intemperence, but to use fermented Liquors such as Wine, Beer and Cider with Moderation.
The College concede Fires to be very ineffectual, if not dangerous means of checking the progress of the Fever. They have reason to place more dependence upon the burning of Gunpowder. The Benefits of Vinegar and Camphire are confined chiefly to infected Rooms, and they cannot be used too frequently apon handkerchiefs or in smellingBottles, bu persons whose duty calls them to visit or attend the sick.
By Order of the College
William Shippen James Vice President
Saml. P. Griffitts Sec.y.
Here’s some historical context, before I dive into why I find #5 and #8 particularly compelling (I am guessing you already have an idea of that anyway).
At the time, a prevailing theory of disease had to do with coming into contact with “bad air,” also sometimes called “miasma.” (check out great scholarship by Conevery Valencius and Gregg Mitman on 18-19th century relations to air and health). Thus, some of their suggestions revolved around getting rid of bad or stagnant air. They suggested doing this by cleaning the city, and to be sure that every place had fresh air, including the bedchambers surrounding people suffering with the fever, and hospital wards for those who did not have airy bedchambers at home. The College informed the State Governor, after receiving a testy letter from him, that they believed the “malignant fever” had been imported, though they were not sure which ship it had come on. So the safety and cleanliness of the ships, and sailors was stressed, as well as the cleanliness of the port, and of the streets, and of houses. Among other things, the College recommended dumping “unslaked lime” on the “necessaries”—toilet areas outside of houses where the contents of chamber pots were disposed.
“To purify the City from latent Infection, we want to recommend that every House, particularly those in which there have been any sick ,should be thoroughly cleaned and kept open, so as to admit fresh air through every Aperture—the Walls should be whitewashed and Gunpowder burned in all the Apartments—the Beds and Woolen Apparell of the Sick should either be destroyed or smoked with gunpowder in a close Room and exposed to the Air and Rain. Unslaked Lime should be thrown down the Necessaries, and the streets should be kept clean, especially in the confined parts of the city.”
Ibn Sina (Avicenna), a physician in the 11th century, as well as several others in the following centuries, proposed early versions of a germ theory of disease by describing the process of contagion. Antoni von Leeuwenhoek was surprised to see what he called “animalcules” in a drop of water upon gazing through the first microscope he created in 1677. Those longstanding voices couldn’t outweigh the force of belief in miasma theory, though, an approach to understanding illness rooted in part in the 2nd century Roman physician Galen of Pergamon’s writings. So a germ-theory approach to what we now call “infections” wasn’t taken up by European medical lore until the late 19th century, after Louis Pasteur’s work on bacteria in food.
In brief, “western” medicine or “biomedicine” approaches to working with what we now call infectious disease are pretty new, relative to the history of human health (that is, all of human history). A hundred and fifty years, more or less. Pharmaceutical antibiotics were developed in the 1920s, but not widely used until the 1940s. That’s eighty years ago. Pharmaceutical antivirals started to emerge in the 1960s, and are most widely used with the herpes family of viruses (which includes HSV1 and 2, as well as shingles, chicken pox, and Epstein-Barr virus). That’s just sixty years ago. Anti-retrovirals for HIV are even newer.
Folks have been working with plants that address bacterial and viral infections for much longer—but, of course, in the last 150 years we’ve collectively changed the landscape in which all kinds of infections operate. So though herbalists are out there working hard to support all kinds of infections (shoutout, folks, to herbalists helping folks understand immune system support and other interventions around viral infections), things look different now than they did in Benjamin Rush’s time. This last is a little bit of a “duh” statement, but I make it because not everything looks different, and that’s why I am so touched by recommendation #5 and #8 above.
Fifth. To put a stop to the tolling of the bells.
In the context of an urban disease outbreak, a bell tolling was a public acknowledgement of a death. When I read this line, I heard in it a plea to City officials to stop the proliferation of panic. To stop the thing that was reminding people every moment of every day that people were dying, dying, dying. Not because the College of Physicians wanted people to forget the seriousness of the outbreak, or to pretend that people were NOT dying. Each toll of the Bell created a different kind of instability in the hearts of the people who heard them. Surviving a pandemic requires more than good medical care—finding moments of equanimity, patience, rest, and grace are also medicine for the heart. Obviously, the College wasn’t under any illusions that less bells tolling would decrease the spread of the outbreak, or give people the opportunity to feel peaceful in every moment, because that’s not possible ever, let alone in the context of an epidemic or pandemic. But ceasing the tolling of the bells could allow citizens to potentially have access to equanimity, patience, rest and grace. More space for the heart and mind, more space for the immune system (though that concept wasn’t yet at play, it certainly is now).
Eighth. To avoid all Fatigue of Body and Mind.
This one, too, I read as the College of Physicians seeking ways to support the capacity of people to respond emotionally, socially, to the infectious outbreak. Rest, rest, rest, they said. Avoid fatigue–even mental fatigue. Rest. Let the bells cease tolling, let us keep in our hearts the fact that people are dying (people are always dying) and many of us are afraid (someone is always afraid) and we are all connected in these entwined communities where we can take care of each other and ourselves (we can always take care of each other and ourselves). Rest.
What would it look like if we allowed these moments, shot through with occasional panic and overdose on news, to be interspersed with rest? With deep rest. With just-sit-the-fuck-down. What would happen to our hearts, if we let ourselves rest—obviously, those who are ill can always already rest, and those who are well can support them in love and caring community. But what if we rest, even when we are not ill? Rest is the nadir of capitalism, I think, and we have in front of us a massive opportunity to rest, and to help others rest. What does it take, in your life, in the lives of the people physically, emotionally, spiritually closest to you, to rest? What would it take for everyone to have consistent access to rest?
How would the world change, how would our communities change, how would our hearts change?
I invite you to pause, close your eyes, and sit with this question for a space of some breaths.
What would it be like if we just let ourselves rest?
Last year I had cancer. I had never noticed before that I didn’t know how to rest, but I learned. I lay on my couch for hours at a time waiting to heal from surgery, from exhaustion, from the mental and physical process of losing so much of what I thought was already mine, from losing parts of my body. Last year on the couch I rested, staring out the window at the flapping flag, and the trees. Skeletons in the winter in the wind. For hours last year, I noticed again for the first time (because each time is the first time) the fact that breath goes in and out of my body. Every day. Multiple times a day. The fact that I breathe, barely thinking about it, all the time. I rested, and noticed this breath. What would it be like if we let ourselves just notice the breath? Our own, and that of the wind? If we rested, and noticed how these breaths move against things?
Living in a pandemic invites us to access our connection with the inexplicable, the mysterious, the wonder—and the ways fear and grief are bound up with the mysterious, not just joy and transcendence. It invites us to show up for our loved ones, for ourselves, to show up for the neighbors we didn’t know, to show up for those who cannot access what they need in order to survive. This is grace, the blessing of the earth, already within each of us, if we listen closely. Maybe, like me, you call that the energies of the earth; maybe you call it essential Buddha nature. You might understand it as agape—divine love, or the wisdom and energy of ancestors echoing down the years.
Living in a pandemic also invites us to reckon with the troubled history of this continent—this is not its only pandemic. Remember smallpox? One of many imported diseases that killed hundreds of thousands of Indigenous people when colonists arrived. How do we live with disease, now, in a way that honors the past, and works to name it, and to build relationships that move towards justice?
May our ancestors who survived the plagues move through us with their strength and courage. May those who did not survive the plagues move through us with their resolve and clarity.
With love and courage,