Director Steven Soderbergh said of his 2011 film Contagion that he wanted to create a situation that was as realistic as possible: a clinical and frightening look at the emergency procedures of the Center for Disease Control during the onset of a rapidly-spreading fictional virus. The disease—signaled in the first minutes by the doomed Gwyneth Paltrow’s dry, convulsive cough—is highly contagious via touch and air, and fatal in nearly all cases, except for those who are inexplicably immune. At its peak, the disease causes riots and looting at suburban grocery stores, neighbors turn against neighbors, the national guard blocks off state borders, and snake-oil cures flood the airwaves. Eventually the scientists of the CDC manufacture a vaccine, which is distributed slowly and methodically through the U.S. population and then worldwide—though for most, too late.

For a contemporary audience, this look behind closed doors, deep into sealed-off labs where the words most dangerous diseases dwell, suggests that our government’s system for managing contagions is perfect, until it is imperfect. It suggests that human existence might again become hostage to some invisible airborne pathogen, and anarchy will rule once more, where there is no reason, no governance, and no society.

1793 was a tender year for the newly United States: the Revolutionary War had come to a close, the Bill of Rights had recently been ratified, and plague of yellow fever had struck the nation's largest city and newest capital, Philadelphia.

Philadelphia housed a majority of the nation’s most prominent families, as well as Congress, including President George Washington, Secretary of the Treasury Alexander Hamilton, Secretary of State Thomas Jefferson. While Philadelphia was the center of discussions on the establishment of a new republic rooted in democracy, the deep and far-reaching decisions ratified by the early Congress would do no good for the immediate demands of public health. Without governance, there was only God, and without the mercy of God, there was only the punishing wrath that Jonathan Edwards had warned of: “There is nothing between you and hell but the air.”

The yellow, or “malignant,” fever first struck during the sweltering summer of 1793, lasting until early the next year, when winter killed off the mosquitoes which carried the disease. At the beginning of August, several of the city’s physicians had started to observe similar symptoms in their patients: nausea, vomiting black bile, lethargy, and an eerie yellow-tinged skin. One of those physicians was Dr. Benjamin Rush, the former Surgeon General for the Continental army, who would act as a journalist-flâneur to the disease-ridden city when he was not caring for its victims, later collecting his writings and publishing them as “an account of the bilious remitting and intermitting yellow fever as it appeared in Philadelphia in 1794.”

When the sickness first arrived, Rush was accused of scaremongering the citizens with “imaginary danger,” but he responded to his critics with still more worry that they “were not terrified enough.” He observed a “strange apathy” in the thriving metropolis, which would lose one in ten—some 5,000 of its 50,000 citizens—over the course of four months.

In his book, Rush describes walking the streets in the middle of September, seeing half of the houses shut-up though he estimates only about a third of the inhabitants had fled the city. George Washington left the president’s house for Mount Vernon on September tenth. Alexander Hamilton and his wife, both afflicted with the fever, were treated poorly on their exodus. The only people seen walking the streets were nurses, doctors, “bleeders,” and those who took on the task of burying the dead. Carriage traffic, Rush reported, was equally as noisy as before, though it consisted entirely of hearses which were often followed by parades of tearful family and friends.

During the initial weeks of the fever a newspaper notice went out, calling for “people of color” to assist those who were ill or dead. There were no designated protocols or people to treat the sick other than available physicians. Two selfless volunteers and members of the Free African Society, Richard Allen and Absalom Jones, noted the prevailing belief that “people of our color were not liable to take the infection.” (This was, of course untrue, though Soderbergh in Contagion would include a set of people inexplicably immune to the disease, without providing any answers as to why.)

They later published a manuscript of their actions: A Narrative of the Proceedings of the Black People During the Late Awful Calamity in Philadelphia in the Year 1793. In the account, Allen and Jones explain that the most difficult task was that of moving and burying the bodies of the dead. With the number of dead rising sharply, and still no real cause identified, the pair scrounged together five more men to help with their thankless service. “It was very uncommon,” they wrote, “to find any one that would go near, much more, handle, a sick or dead person.”

Another forward-thinking citizen, Stephen Girard, was able to take over and convert a mansion called Bush Hill located one mile from the city. Bush Hill became a pseudo-hospital, but according to Allen and Jones, it was initially “as wretched a picture of human misery as ever existed.” A group of its nurses and attendants looted much of the supplies. Patients were left unattended at all hours unless the doctors were in. Allen and Jones described its horrors:

The dying and dead were indiscriminately mingled together. The ordure and other evacuations of the sick were allowed to remain in the most offensive state imaginable. Not the smallest appearance of order or regularity existed. It was in fact a great human slaughterhouse, where numerous victims were immolated at the altar of intemperance.

Though the “hospital” staggered to attain any positive benefit for its patients, Dr. Rush’s account suggests the house took until late September to organize, eventually under control by an American and French physician who “governed with the order and cleanliness of an old and established hospital.”

Medicine at this point was still an inheritor of the medieval humors, coupled with a theory of “miasmas” which held that disease came from the airborne emanations of decaying animal and vegetable matter, or really anything putrid. The fever brought on medical debates over who was susceptible, the origins and, though it was commonly called a “contagion,” whether it was, in fact, contagious—in this case of yellow fever, spread by mosquitoes, it wasn’t. The onslaught of the fever came with the swampy summer, and died in the winter, along with its carriers.

Rush writes that a “more serious source of the distress of the city arose from the dissensions of the physicians” and that the fever’s “various grades and symptoms were considered as so many different diseases, all originating from different causes.” Treatments were equally as conflicted. Rush recommended bloodletting and liberal administration of mercury while others suggested burning all garments. It wasn’t until 1901 that U.S. Army Officer Walter Reed would postulate that yellow fever was transmitted by a specific South American female mosquito.

Once the shock of the onset was over and there was enough time for the panic to settle, the mood in the city began to take a moral turn. Allen and Jones gave an exacting account of the money they received for disposing of bodies in order to refute claims of theft and extortion. They also contest “a generally received opinion” that blacks were not as liable to the fever as whites. They even argued, with anecdotal evidence, that they “have seen more humanity, more real sensibility from the poor blacks, than from the poor whites” who shunned any duty to others and “hid themselves.”

The seemingly arbitrary nature of the illness, incomprehensible without a basic understanding of disease, turned many thoughts to a Prime Mover. It became apparent to preacher John D. Mason that “the Lord is dealing with us in wrath” and the fever is evidence that “God accomplishes, by natural means, the wise and holy ends of his moral government.” Mason boldly suggested the “divine displeasure” is with America in particular, citing the recent wars with England and Indians not to mention the young country’s “unbecoming pride” and “insincerity.” His diagnosis: “receive the savior or perish.”

As always, Dr. Rush tried to see the positive side of the epidemic, writing some observations of the effects of “the mortal epidemic on the morals of the people.” Rush wrote that many remarked how the name of the “Supreme Being” was rarely profaned either on the streets or amongst one another. There were only two robberies of a “trifling nature,” despite the fact that so many houses were open to looting. Many religious groups increased meetings to three times every week. Declining to go into detail with his individual account of the many virtuous acts he witnessed, Rush instead reflected on how the whole “United States wept for the distresses of their capital.” 

After the winter blighted the disease, the fever would return at least once more to Philadelphia and then on to New York, though without nearly as many fatalities. But the devastation of 1793 spurred the creation of a Board of Health in Pennsylvania, which built the Lazaretto, a large house dedicated to housing the sick. A waterworks was successfully installed by 1822, with generous support from Benjamin Franklin’s will, which allocated an enormous bequest to his beloved city.

Epidemics like the yellow fever caused the youthful nation to reflect on its shared mortality. More than war, the death by seeming “contagion” was an unseen enemy—it arrived as indiscriminately as it left. Though “never forget” may now be cliché, novelist Charles Brockden Brown—who survived the fever only to lose his best friend—was haunted by the fever’s terrible toil:

The evils of pestilence by which this city has lately been afflicted will probably form an era in its history. The schemes of reformation and improvement to which they will give birth, or, if no efforts of human wisdom can avail to avert the periodical visitations of this calamity, the change in manners and population which they will produce, will be, in the highest degree, memorable…They have not been less fertile of instruction to the moral observer, to whom they have furnished new displays of the influence of human passions and motives.