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Category Archives: Health

Everyone else is gone. SOMEONE needs to stay in town.

The Presidt. [Washington] goes off the day after tomorrow as he had always intended. Knox [Secretary of War] then takes flight. Hamilton [Secretary of Treasury] is ill of the fever … I would really go away, because I think there is rational danger, but that I had before announced that I should not go till the beginning of October, & I do not like to exhibit the appearance of panic. Besides that I think there might serious ills proceed from there being not a single member of the administration in place.
Thomas Jefferson to James Madison, September 8, 1793

In the face of coronavirus, I’m excerpting correspondence about the 1793 yellow fever epidemic in Philadelphia, the nation’s capital at the time, which killed 5,000 of the city’s 50,000 residents.

Patrick Lee’s Explanation
Responsible leaders put themselves at risk for the cause.
Secretary of State Jefferson wrote his friend Madison that Hamilton was ill and other senior government officers were leaving Philadelphia to escape the yellow fever epidemic. (There is no mention of the whereabouts of VP John Adams and Attorney General Edmund Pendleton.) He preferred to leave himself in the face of “rational danger.”

However, he had previously made it known he would stay in Philadelphia until October. If he left, too, it might “exhibit the appearance of panic” to a city already engulfed in panic. Also, he thought it unsafe to leave the nation’s capital with “not a single member of the administration in place.” For reasons both domestic and foreign, he would leave himself at risk.

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NOTE: The link to Thomas Jefferson’s letter is subject to change by Founders’ Archive. It was accurate when this post was written. If the link is now wrong, search FoundersArchives.gov or call me. I’ll help you find it.
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What to do when no one knows what to do?

The yellow fever increases. The week before last about 3. a day died. This last week about 11. a day have died; consequently from known data about 33. a day are taken, and there are about 330. patients under it. They are much scattered through the town, and it is the opinion of the physicians that there is no possibility of stopping it. They agree it is a non-descript disease [without distinctive features or characteristics], and no two agree in any one part of their process of cure.
Thomas Jefferson to James Madison, September 8, 1793

In the face of coronavirus, I’m excerpting correspondence about the 1793 yellow fever epidemic in Philadelphia, the nation’s capital at the time, which killed 5,000 of the city’s 50,000 residents.

Patrick Lee’s Explanation
Sometimes there are no answers.
Secretary of State Jefferson reported to friend and Congressman Madison at home in Virginia on the yellow fever devastating Philadelphia. Evidence-based medical practice was in its infancy, yet all doctors, college trained or self-taught, agreed on two things:
1. There was no uniform description of the disease.
2. There was no way to stop it.

NOTE: The link to Thomas Jefferson’s letter is subject to change by Founders’ Archive. It was accurate when this post was written. If the link is now wrong, search FoundersArchives.gov or call me. I’ll help you find it.
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In a crisis, panic makes reality worse.

A malignant fever [in] Philadelphia … has given great alarm. It is considerably infectious … Tho there is some degree of danger, yet, as is usual, there is much more alarm than danger; and knowing it to be usual also to magnify these accounts in proportion to distance, I have given you the particulars, that you may know exactly what the case is.
Thomas Jefferson to Thomas Mann Randolph, Jr., September 2, 1793

In the face of coronavirus, I’m excerpting correspondence about the 1793 yellow fever epidemic in Philadelphia, which killed 5,000 of the city’s 50,000 residents.

Patrick Lee’s Explanation
Wise leaders also address the alarm that arises in crises.
Jefferson wrote his son-in-law, Martha’s husband, about the fierce yellow fever plague attacking Philadelphia. Although Randolph was inland, several hundred miles away and safe from the scourge of disease, he could not escape the alarm spread by newspaper accounts and gossip.

Jefferson believed there was “more alarm than danger,” and the alarm was magnified the further it traveled. Thus, he reported accurately the situation in Philadelphia to his family, that the alarm might not exceed the reality.

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NOTE: The link to Thomas Jefferson’s letter is subject to change by Founders’ Archive. It was accurate when this post was written. If the link is now wrong, search FoundersArchives.gov or call me. I’ll help you find it.

 

 

 

https://founders.archives.gov/?q=%22yellow%20fever%22%20Author%3A%22Jefferson%2C%20Thomas%22&s=1111311113&r=6

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Everyone who can flee the disease is doing so.

A malignant fever … in the filth of Water street which gives great alarm. About 70. people had died of it two days ago, & as many more were ill of it… now got into most parts of the city & is considerably infectious. At first 3. out of 4. died. Now about 1. out of 3. It comes on with a pain in the head, sick stomach, then a little chill, fever, black vomiting & stools, & death from the 2d. to the 8th. day. Every body, who can, is flying from the city, and the panic of the country people is likely to add famine to disease. Tho becoming less mortal, it is still spreading, and the heat of the weather is very unpropitious. I have withdrawn my daughter from the city, but am obliged to go to it every day myself.
Thomas Jefferson to James Madison, September 1, 1793

For several years, I have been excerpting Thomas Jefferson’s letters sequentially during his presidency. In light of the coronavirus, I am reverting to much earlier letters that address the plague of yellow fever along the Atlantic coast.

Patrick Lee’s Explanation
Realistic leaders know plagues attack every generation.
Jefferson was President Washington’s Secretary of State in 1793 when the nation’s capitol was in Philadelphia. It was a tidewater city, meaning Delaware River levels rose and fell with the Atlantic tides, creating swampy areas in the city. One of those, “in the filth of Water street,” had given rise to the yellow fever, which attacked all tidewater areas every August and September.

Jefferson wrote the disease was “considerably infectious” and had spread to most of the city of 50,000. Three-fourths of its earliest victims died, but that level had dropped to one-third. “About 70. people” had died on a single day two days before. Everyone who could flee the city was doing so. He feared panic would spread to the farmers who would refuse to bring their produce to the city’s markets, adding famine to the scourge of disease.

The disease was still expanding. He had sent his 15 year old daughter, Maria, away from the city, but his duties required him to be there every day.

The 1793 plague would kill 5,000, 10% of the city’s population.

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NOTE: The link to Thomas Jefferson’s letter is subject to change by Founders’ Archive. It was accurate when this post was written. If the link is now wrong, search FoundersArchives.gov or call me. I’ll help you find it.
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Social distancing, Thomas Jefferson style

…the yellow fever …is generated only in low close, and ill-cleansed parts of a town, I have supposed it practicable to prevent it’s generation by building our cities on a more open plan. take for instance the chequer board for a plan. let the black squares only be building squares, and the white ones be left open, in turf & trees. every square of houses will be surrounded by four open squares, & every house will front an open square. the atmosphere of such a town would be like that of the country, insusceptible of the miasmata which produce yellow fever. I have accordingly proposed that the enlargements of the city of New Orleans … shall be on this plan.
To Constantin François Chasseboeuf Volney, February 8, 1805

Patrick Lee’s Explanation
Visionary leaders plan with public health in mind.
This excerpt is a duplicate, from September 10, 2019, but with a twist, in light of the coronavirus.

Jefferson addressed the scourge of yellow fever, which ravaged coastal and tidewater cities in August and September each year. (In 1793, it killed 5,000 in Philadelphia, a city of 45-50,000.) He believed the cause was “miasma,” an unhealthy vapor arising in crowded, dirty cities, suffering from a shortage of fresh air.

Since New Orleans, also on the tidewater, had recently been added to the U.S., he proposed future expansions of that city be made on a checkerboard plan. All development would be on squares of one color only. All squares of the other color were to be left open. Thus, every populated block would have blocks of green space on all four sides. This would provide for less disease through social distancing, as a matter of urban design.

It would be nearly a century before the cause of yellow fever was discovered, not miasma but mosquitoes that thrived in the the swampy, tidewater environment.

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NOTE: The link to Thomas Jefferson’s letter is subject to change by Founders’ Archive. It was accurate when this post was written. If the link is now wrong, search FoundersArchives.gov or call me. I’ll help you find it.
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Green space urban design will lessen disease.

…the yellow fever …is generated only in low close, and ill-cleansed parts of a town, I have supposed it practicable to prevent it’s generation by building our cities on a more open plan. take for instance the chequer board for a plan. let the black squares only be building squares, and the white ones be left open, in turf & trees. every square of houses will be surrounded by four open squares, & every house will front an open square. the atmosphere of such a town would be like that of the country, insusceptible of the miasmata which produce yellow fever. I have accordingly proposed that the enlargements of the city of New Orleans … shall be on this plan.
To Constantin François Chasseboeuf Volney, February 8, 1805

Patrick Lee’s Explanation
Compassionate leaders promote public health.
Thomas Jefferson met the French philosopher Volney (1757-1820) during his service in France. More than half of this lengthy, wide-ranging letter dealt with the ravages of yellow fever in coastal America. Jefferson fled swampy Washington for Monticello every August and September, when the disease was prominent.

Jefferson presumed the disease flourished because of crowded, unhealthy living conditions in large cities, all in the Atlantic tidewater region. To combat this, he proposed a plan for future urban expansion that would leave half of every development in green space. Using the example of a checkerboard, he suggested all squares of one color for homes, all squares of the other color to be left natural. Every house on the block would front on open space.

It would be long after Jefferson’s death before the cause of yellow fever was discovered. It wasn’t the crowded swampy atmosphere along the coast, but the mosquitoes that thrived in that environment.

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Give it to me straight!

Your letter of the 11th. was recieved and gave me the first intimation of your illness. it has filled me with anxiety respecting you, and this is increased by your not having communicated it to me. because in endeavoring to spare my feelings on your real situation it gives me the pain of fearing every thing imaginable; even that the statement of your recovery may not be exact. let me pray you always to give me the rigorous state of things that I may be sure I know the worst.
Thomas Jefferson to Martha Jefferson Randolph, January 21, 1805

Patrick Lee’s Explanation
Should a leader prefer bad news to no news at all?
Martha’s January 11 letter to her father has disappeared, so we do not know the nature or extent of her illness. Just eight months before, her sister and Thomas Jefferson’s only other child had died. He greatly feared for Martha’s safety.

Not only had Martha’s letter filled him “with anxiety,” he feared she was trying to spare his feelings. That made his worry all the worse, even doubting her assurances about her own recovery.

He wanted to “know the worst” about his only child’s health. That was not as bad as not knowing and an imagination run amok.

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Cancer is not within the federal government’s authority.

… with respect to any application to Congress, it would be inefficient, because the Constitution allows them to give no other reward for useful discoveries but the exclusive right for 14. years: and the care of the public health is not among those [powers] given to the general government, but remains exclusively with the legislatures of the respective states …
To James Houston, February 10, 1804

Patrick Lee’s Explanation
Wise leaders accept limits on their authority.
In a long curious letter to the President, Houston, a 52 year old farmer described being in Philadelphia for treatment of a cancer he’d suffered from for many years. He claimed to have been mostly healed and wanted to make the doctor’s cure known publicly. The doctor refused, because the pills he compounded to treat the cancer were a major source of income. Still, for $50,000, the doctor would release the formula.

Houston had written a “pamphlet,” some lengthy, rhyming narrative of his treatment and cure, and sent a portion of it to the President. He hoped to publish and sell it to raise funds toward that $50,000 goal. He sought a patent on his pamphlet. The President acknowledged a 14 year patent “for useful discoveries,” but that did not apply to Houston’s effort. Neither was the national government authorized by the Constitution to guard public health. Under the 10th Amendment, that authority remained with the individual states.

While he could not help his petitioner, Jefferson remained gracious. He concluded his letter by congratulating Houston “on his prospect of recovery, and sincerely wishes it may be compleated.”

Two months later, Houston filed for a copyright on his pamphlet in the federal court in Philadelphia and published it with the title, “A Plan for the Ladies Fund, in the United States of America, for the Relief of Those Afflicted with Cancers.”

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“a knock of the elbow,” but get the doctor, too.

Not knowing the time destined for your expected indisposition, I am anxious on your account. you are prepared to meet it with courage I hope. some female friend of your Mama’s (I forget who) used to say it was no more than a knock of the elbow. the material thing is to have scientific aid in readiness, that if any thing uncommon takes place, it may be redressed on the spot, and not be made serious by delay. it is a case which least of all will wait for Doctors to be sent for. therefore, with this single precaution, nothing is ever to be feared.
To Mary Jefferson Eppes, December 26, 1803

Patrick Lee’s Explanation
Confident leaders can still be anxious fathers.
Mary Eppes, known as Maria, was the President’s younger daughter. She was one of two Jefferson children who survived childhood, which had claimed four others.

The “expected indisposition” referenced was the upcoming delivery of her third child. Her first son, born in 1800, lived only a few days. Her second son, Francis, was now 27 months old. Like her mother who died of childbirth complications in 1782, Maria was not a strong, healthy woman. She had suffered considerably after the birth of her first two children.

Very rarely did Jefferson refer to his long deceased wife Martha, but he did so here. No doubt wanting to lesson Maria’s anxiety, and probably his own, he relayed a comment of a friend of his wife’s that childbirth “was no more than a knock of the elbow.” Even so, he urged his daughter “to have scientific aid in readiness,” i.e. a doctor. The onset of labor would provide time to summon the doctor so any help could be rendered immediately. A knock or not, with this precaution, Maria had nothing to fear.

Time would tell that both daughter and father had plenty to fear.

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Family & health come first, before leadership!

Having understood that you have been unwell, & that your family is still so, I have not asked your attendance here, lest these circumstances should stand in the way. Mr. Madison, Dearborne & Gallatin are here & mr Lincoln expected tomorrow … should your own health or that of your family not render it inconvenient we should be very happy to see you on Monday & to recieve your aid at a meeting which I propose for Tuesday next. but this is not meant to be pressed against considerations of health or of family distress.
To Robert Smith, September 30, 1803

Patrick Lee’s Explanation
Thoughtful leaders are sensitive to the difficulties of their associates.
Smith (1757-1842) was Jefferson’s Secretary of the Navy. As a member of the Cabinet, his attendance was needed very soon. All the other cabinet members would arrive in Washington City the following day. In addition to other business to bring before Congress, they faced the critical issue of the constitutional amendment needed to authorize the purchase of Louisiana. Prompt action from a united front was critical.

Yet, both Smith and his family were ill. While the President greatly hoped for his Secretary’s attendance and help at the Cabinet meeting four days hence, he stressed that Smith’s health and family came first.

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