In late July 1800, Gov. James Monroe learned of a yellow fever outbreak in Fredericksburg, Va. Local officials were able to trace the source of the virus to Norfolk, a major port town on the mouth of Chesapeake Bay. Monroe’s actions over the next several months prevented a statewide outbreak of the fatal disease and serve as a helpful case study for the government’s role during a pandemic.
It offers an interesting example of how partisan ideology can coexist with government response to infectious disease. Monroe was an ardent Jeffersonian-Republican. He adored the French, abhorred the British, despised John Adams, grew to be frustrated with George Washington, admired James Madison and worshipped Thomas Jefferson. He had campaigned against the ratification of the Constitution, fought against the Federalists that championed executive power, and spoke out in favor of states’ rights. Few people were more opposed to strong central government.
And yet, when serving as governor of Virginia, he didn’t hesitate to take drastic steps to protect his state and limit the spread of the disease. Even Monroe, the most partisan of Republicans, distinguished between political ideology and public health emergency. It’s a compelling story.
On Aug. 8, Monroe left his home in Albemarle and traveled to the capital in Richmond. After meeting with his Council of State, Monroe issued a proclamation on Aug. 23, which required a quarantine for all vessels traveling to and from the city, whether they be tiny canoe or large ship. Monroe worked with the mayors of Richmond, Petersburg, Alexandria, Fredericksburg, and Williamsburg to coordinate the efforts. The quarantine required major cities that regularly traded with Norfolk to create designated examination stations. Each city would also select land near the quarantine stations and build temporary housing. Monroe instructed the mayors to house and care for all symptomatic individuals at these designated locations.
Critically, this care would be provided at the state’s expense, regardless of the class or citizenship of the individual: “It is an object of great importance to humanity as well as the general interest of Society that Such unfortunate persons be accommodated in Such manner as to secure them all the aid that can be furnished for the restoration of their health, and that all intercourse between them and the people of the Neighbourhood be completely prevented.” Sailors arriving on foreign ships would receive the same care as locals to prevent the spread to nearby cities.
On Nov. 4, 1800, Monroe lifted the quarantine after the threat had subsided. His coordinated action with local mayors produced much better results than recent pandemics. Although Norfolk lost 250 people during the outbreak, roughly 3 percent of the city’s population, the numbers were far lower than other yellow fever outbreaks around the same time.
In 1793, roughly 10 percent of Philadelphia’s population died from yellow fever — 5,000 of the 50,000 residents. Up to 20,000 Philadelphians with money and somewhere to go fled, including most of the doctors in the city. While 18th-century Americans didn’t know the cause of the disease (mosquitoes) or how to treat it, they observed that nursing and hydration helped ameliorate the side effects and encourage recovery. Unfortunately, most residents that remained in Philadelphia didn’t have the funds to hire nurses or doctors to provide health care, which meant that the poorest neighborhoods in the city were particularly devastated by the outbreak.
Monroe’s coordinated action and provision of care likely produced the different outcome of 1793 and 1800 outbreaks. Rather than each city implementing its own haphazard quarantine, Monroe enforced unilateral action across the state and prevented the disease from hopping from port to port. Norfolk’s role as a critical hub for Virginia’s commerce made centralized action especially important. Ships arriving from across the Atlantic or other states stopped in Norfolk to purchase food and supplies before heading up the James River to Richmond, the Rappahannock River to Fredericksburg, or the Potomac River to Alexandria or Washington, D.C. All of these cities were vulnerable to yellow fever outbreaks because mosquitoes thrived in the humid summer weather. Additionally, ships carrying goods produced in Virginia stopped in Norfolk before traveling onto their final destination up and down the coast, or across the Atlantic. Without statewide restrictions, the disease could have easily spread across the state and the country.
The provision of public health care also curtailed the effect of the pandemic. In 1793, some poor Philadelphians received care at local hospitals staffed by volunteer nurses, but most did not. In 1800, Monroe ensured that all individuals received care. While the numbers are difficult to quantify, state-sponsored health care likely reduced the mortality rate and spread of the disease.
Over the last few months, there have been countless news stories about the 1918 Spanish flu pandemic and the 1793 yellow fever outbreak in Philadelphia. We know about these stories because the disease spread and thousands of lives were lost. But the outbreak of 1800 is the example we should remember.