"We know that six pounds was demanded by and paid to a white woman, for putting a corpse into a coffin; and forty dollars was demanded and paid to four white men, for bringing it down the stairs." Philadelphia's newspapers continued to publish during the epidemic, and the doctors and others tried to understand and combat the epidemic. Like Rush, he thought poisons had to be "abstracted" in severely debilitated patients. Heated debate among the College of Physicians erupts, at first due to disagreements over the identification and cause of the disease, and later over Rushs cure. Absalom Jones: Was involved in the building of the St. George's United Methodist Church and, after participating and helping build the church, was told to sit in the back of the church by the church leaders. -Graham S. Philadelphias yellow fever epidemic killed nearly 5,000 people between August and November, 1793nearly 10% of the citys population. [28], Rush claimed that he had tried Kuhn's and Steven's stimulating remedies but that his patients still died. It was, in fact, a great human slaughter-house. Also, the fever originally came from present day Haiti. Worldwide, between 1,000 and 2,000 cases each year are . Eventually, a cold front eliminated Philadelphias mosquito population and the death toll fell to 20 per day by October 26. Many never walked on the footpath, but went into the middle of the streets, to avoid being infected in passing by houses wherein people had died. Baptized a child. WANT A NOOK? 55 reviews 3 followers. Very readable history. My students love how organized the handouts are and enjoy tracking the themes as a class., Requesting a new guide requires a free LitCharts account. The market days continued, and bakers continued to make and distribute bread. Contrary to this misguided belief, the plague did infect white San Franciscans; but in the beginning, it hit residents of Chinatown the hardest. Changing the day will navigate the page to that given day in history. [73] He preferred "acidulated" water to the use of Peruvian bark as many patients found the bark distasteful. The death toll from a yellow fever epidemic in Philadelphia hits 100 on October 11, 1793. The most interesting parts were in the last quarter of the book. The Lord was plentiful to strengthen us, and removed all fear from us[24], In order the better to regulate our conduct, we called on the mayor the next day, to consult with him on how to proceed, so as to be the most useful. This book tied in with a few other books I have read this year. The worst seven-day period was between October 7 and 13, when 711 deaths were reported.[22]. the beginning part is fine, but the last chapter or so is paralyzingly terrifying. Early in her career, she worked at the. [34] On September 12, Clarkson summoned fellow citizens interested in helping the Guardians of the Poor. I found this informative and very readable. watchmen were supposed to guard. Interesting history of Philadelphia at the time. Before his full-time appointment in 2011 at Hoover Institution, he was Professor and Chief of Neuroradiology at Stanford University Medical Center for 14 years. Mosquito bites transmit the virus. But on informing him of the cause, i.e. Listen to "An American Plague The True and Terrifying Story of the Yellow Fever Epidemic of 1793" by Jim Murphy available from Rakuten Kobo. Imagine that? Excerpt: 'The American Plague' The author draws on primary sources for this nonfiction book recommended by Washington Post. The mortality rate that year was roughly the same as it had been at Bush Hill in 1793, despite radical difference between the therapies used. The first major American yellow fever epidemic hit Philadelphia in July 1793 and peaked during the first weeks of October. For three months nothing happened in the government, no laws were passed, no meetings, nothing and yet the world still went on, and this at a time much more critical than normal, when part of the population wanted another revolution to go along with the French Revolution, and the entire country was only a few years old. The meetinghouse is not far from the waterfront where the epidemic had started. Most interesting person Murphy discusses: the resplendently named Israel Israel, who risked his life helping others but then was cheated out of an election because he dared to suggest that Philadelphia should do more to help its poor people. ditch the last chapter tho. The doctors did not understand the origin or transmittal of the disease. The people were hungry. There was a real fear that the discovery of more plague victims would lead to more quarantines or building-burning, a crude method of fighting disease. About two months into the epidemic, however, Rush was proven wrong and Black people began to fall ill, dying from yellow fever at about the same rate as whites. LitCharts Teacher Editions. Despite his many accomplishments, the thought of hosting SNL has always filled him with . Yellow fever, or American plague as it was known at the time, is a viral disease that begins with fever and muscle pain. With the discovery of a spring on the estate, workers were organized to have clean water pumped into the hospital. Caring for the victims so strained public services that the local city government collapsed. An American Plague: The True and Terrifying Story of the Yellow Fever Epidemic of 1793 by Jim Murphy is an informational text that brings the epidemic alive in such detail that you can feel the sorrow and fear on every page. Sarah Bass, a poor black widow, gave all the assistance she could, in several families, for which she did not receive any thing; and when any thing was offered her, she left it to the option of those she served. [53], Doctors, preachers, and laymen all looked to the coming of autumn to end the epidemic. I have to agree with other reviewers who say this is not for kids, even though it seems to have won some children book awards. Read reviews for average rating value is 3.0 of 5. Philadelphia, then the nation's capital, was the most cosmopolitan city in the United States. The end of the book examines developments around yellow fever since 1793. He preferred to apply heat, using hot bricks on hands or feet. Some of those who stayed behind, like the Free African Society, Benjamin Rush, and members of the mayors committee, are negatively judged in the aftermath. The plague itself is based on several cholera and plague epidemics that swept through Oran during the late 19th and early 20th centuries. 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. What people are saying - Write a review. [35], On the 14th, Clarkson was joined by 26 men, who formed committees to reorganize the fever hospital, arrange visits to the sick, feed those unable to care for themselves, and arrange for wagons to carry the sick to the hospital and the dead to Potter's Field. Norfolk; June-Oct . His wife, Alison Blank, confirmed the death but said the cause was not yet known. Dang, that is some tough content for young readers. Group portrait of health workers with brooms, sprinkling cans, axes, hoses, rakes, shovels and other equipment used to destroy rat habitation areas, standing in front of the storeroom (on left) and U.S. Public Health Marine Hospital Service District Headquarters during the San Francisco plague campaign. (Franklin never published the letters.) Rush, who believed that Black people were immune to yellow fever, asked members of the African Society to come forward and care for to the sick and the dead. "Yearly Meeting Epistle 1793," Swarthmore College Library Quaker Collection; see also letter by Margaret Morris to her daughter August 31, 1793, Haverford College Library Manuscript Collection. On August 3rd,1793 the first death from Yellow Fever was recorded in Philadelphia. Natives thought that newcomers especially had to undergo a "seasoning" and were more likely to die of what were thought to be seasonal fevers in their early years in the region. A fascinating review of an event not so long ago that could be repeated in our heavily populated cities and poorly prepared hospitals. The recurrences of yellow fever kept discussions about causes, treatment and prevention going until the end of decade. This is the story of how half the city's residents fled and half of those who remained died; neighboring towns, cities and states barricaded . It is an exciting portrayal of a somber event in our national history, which helped us better understand the full impact of this tragedy and disease. The book takes place during the 1793 Philadelphia yellow fever epidemic. Newbery Honor and Boston Globe/Horn Book Honor-recipient Jim Murphy has written numerous stories based on historical events, such as The Boys' War and The Great Fire. Most of the Common Council members fled, along with 20,000 other residents. Since Philadelphia was the temporary capital of our young nation the epidemic all but shut down the government. Doctors tried a variety of treatments but knew neither the origin of the fever nor that the disease was transmitted by mosquitoes (this information was not verified until the late 19th century). New York doctors finally admitted that they had had an outbreak of yellow fever in 1791 that killed more than 100 people. Acquaintances and friends avoided each other in the streets, and only signified their regard by a cold nod. Critics that were able to engage with the book found it to be very intriguing. It relates the medical practices of the day, such as blood-letting, the use of mercury and other remedies considered of questionable (at best) value today. Austin American-Statesman. The death of a 10-year-old in Colorado has been linked to plague as state health officials warn they are investigating reports of the bacterial infection in animals and fleas. Ive read one book about the plague in another city. Yet in families, when the person with the fever was a mother or father, they could forbid their children from coming near them. Finally on November 13, stagecoaches resumed service to the north and south. Filled with photographs. He also left a diary. He is able to describe how horrid this period of time was for history with solid research and amazing facts. In the summer of 2019, reports of prairie dogs with plague-carrying fleas forced parts of Colorados Rocky Mountain Arsenal National Wildlife Refuge to shut down. He is the first to identify the disease as yellow fever, though doctors initially remain divided on this point. Wright a staff writer at The New Yorker, where the article that "The Plague Year" is based on first appeared has performed a virtuoso feat and given us a book of panoramic breadth. We strive for accuracy and fairness. Benjamin Franklin had given him letters sent by Dr. John Mitchell, related to treating patients during a 1741 yellow fever outbreak in Virginia. The nodes in the armpit, groin and neck can become as large as . It . quick and informative read. On September 16 he reported that his church was "very full" the day before. Blue helped end the outbreak with initiatives to clean the city and eradicate its rats, whose fleas were infecting humans with the plague. 2023, A&E Television Networks, LLC. In the earlier 1700s, coffeehouses were mere commercial endeavors, but by Mattie Cooks day, coffeehouses functioned more like inns, restaurants, or social gathering spaces. It contains pictures and illustrations, including pages from a list compiled of the dead. Can Congress be convened anywhere but at the capital? Volunteers establish a hospital called Bush Hill and work to clean up the city. It is a recounting of the events surrounding an outbreak of yellow fever in Philadelphia in 1793. Defunct Winner UID: 2 094. Becky Little is a journalist based in Washington, D.C. It gets its name from the swollen lymph nodes (buboes) caused by the disease. All Rights Reserved. 2023, A&E Television Networks, LLC. Rush thought that the outbreak had originated in a pile of rotting coffee beans left on the docks. The 10-year-old . $9.99 Learn more. 6. Chase says, It was very likely the delay in controlling the San Francisco plague allowed it to spreadand persist. [4] Murphy spotlights the heroic role of Philadelphia's free blacks in combating the disease, and the Constitutional crisis that President Washington faced when he was forced to leave the city and all his papers while escaping the deadly contagion. [6] In 1793 Philadelphia was the temporary capital of the United States, and the government was due to return in the fall. In the 18th and 19th centuries, yellow fever killed more than 100,000 Americans. While he deprecated Rush's harsh purgatives and "heroic" bleeding, he moderately bled patients and also used medicines to evacuate the bowels. Major scientific advancements in medicine toward the end of the 1800s and early 1900s allow doctors to definitively determine the female mosquito Aedes Aegypti as the cause. The plague strikes people from all social classes and positions, which only highlights the absurdity and arbitrariness of such hierarchies. [29], In his 1794 account of the epidemic, Mathew Carey noted that other doctors claimed to have used calomel (a mercury compound) before Rush and that "its efficacy was great and rescued many from death." Black Death, pandemic that ravaged Europe between 1347 and 1351, taking a proportionately greater toll of life than any other known epidemic or war up to that time. Beginning in August 1793, the death toll had risen to hundreds of people daily by November of that same year. [78], American doctors did not identify the vector of yellow fever until the late nineteenth century. They refused. Except where otherwise noted, this work is subject to a Creative Commons Attribution 4.0 International License, which allows anyone to share and adapt our material as long as proper attribution is given. The author made the book interesting while presenting a good historical narrative of the events. Elizabeth Drinker, a married Quaker woman, kept a journal for years; her account from August 23 through August 30 tells the quickening story of the spread of the disease in the city and the rising toll of deaths. An American Plague: The True and Terrifying Story of the Yellow Fever Epidemic of 1793 is a 2003 nonfiction adolescent history by author Jim Murphy published by Clarion Books. As the population fled or died, few were left to attend to nursing and burying duties. He hired Jean Devze, a French doctor with experience treating yellow fever in Saint-Domingue (now Haiti). chose to stay and act by breaking laws. The college published a letter in the city's newspapers, written by a committee headed by Rush, suggesting 11 measures to prevent the "progress" of the fever. Autopsies after their death revealed stomachs destroyed by such purges. Their efforts, though praised by Rush, were scorned by the white public as being profiteering and extortionist. Upon which we and a few others met and consulted how to act on so truly alarming and melancholy occasion. Among its many accolades, An American Plague was a Newbery Honor book and a finalist for the National Book Award. Likely the first fictional treatment of the yellow fever epidemic was a novel titled Arthur Mervyn; or, Memoirs of the Year 1793, published in 1799 by Philadelphia native Charles Brockden Brown. [] Yellow fever eroded public virtue, the cornerstone of a health republic. And like many others in California, Gage wasnt even sure white people could get the plague in the first place. Doctors also became ill and died, and fewer were available to care for patients. On the same day a woman he was treating turned yellow. From him he went to another, that vomited offensive matter that would have disheartened any other than this wonderful man. in San Francisco, California during the San Francisco plague campaign. columnist John Kelly, . To keep the body open he recommended more calomel or small doses of cream of tartar or other salts. He later discussed treatment in his memoir, which included 18 case studies and descriptions of several autopsies. A little dry as an audio book. its not *ABOUT* the yellow fever epidemic in Philadelphia in 1793. 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. The city is hit with an incurable and unknown disease which kills about 50% of the people affected. Episode 1 of the 12-part podcast History's Great Plagues, published by Learn25. metaldevastationradio.com [3] They crowded the port of Philadelphia, where the first yellow fever epidemic in the city in 30 years began. AN AMERICAN PLAGUE: The True and Terrifying Story of the Yellow Fever Epidemic of 1793 Jim Murphy, . some people felt a sense of duty. 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. He sent for us, and requested we would use our influence to lessen the wages of the nurses. Integrating newspapers, diaries, personal testimonies and period illustrations, the narrative delivers a social and medical history of the times and raises chilling questions about the disease today. Also, the aspect of scentists battling an unknown disease with some unfortunate consequences. It trailed yellow fever at every port of call in the Caribbean and eastern Atlantic seaboard. Erica has taught college English writing and literature courses and has a master's degree in children's literature. Most did not return until after the epidemic had abated in late November. Many black nurses served without compensation: "A poor black man, named Sampson, went constantly from house to house where distress was, and no assistance, without fee or reward. "Pestilence" and the Printed Books of the Late 15th Century, Spanish Influenza in North America, 1918-1919, Tropical Diseases and the Construction of the Panama Canal, 1904-1914, Tuberculosis in Europe and North America, 1800-1922, Records of the American Academy of Arts and Sciences, Lloyd E. Hawes Collection of Autographed Letters, Richard James Hooker Collection of Letters from American Women, President of Harvard University Records, Abbott Lawrence Lowell, Kopperman, Paul E. Venerate the Lancet: Benjamin Rushs Yellow Fever Therapy in Context.. I picked up this book after the book that Jim Murphy wrote about the great Chicago fire. Residents of Chinatown, in turn, sometimes hid the bodies of plague victims to prevent further discrimination against their community. An American Plague was one of the finalists in the 2003 National Book Award and was a 2004 Newbery Honor Book. In the South, planters and other wealthy people usually left the Low Country during this season. [42], As the death toll in the city rose, officials in neighboring communities and major port cities such as New York and Baltimore established quarantines for refugees and goods from Philadelphia. He was 74. [45], In his 1793 account of the epidemic, Mathew Carey contrasted the sacrifices of men like Joseph Inskeep, a Quaker who served on the Mayor's Committee and also visited the sick, with the selfishness of others. Two French doctors, Jean Devze and Nassy, published shorter accounts. Rush wrote accounts of the 1797, 1798, and 1799 epidemics in Philadelphia. Plague is an infectious disease caused by a specific type of bacterium called Yersinia pestis. J. Henry C. Helmuth, who led the city's German Lutheran congregation, wrote A Short Account of the Yellow Fever in Philadelphia for the Reflecting Christian. But if you see something that doesn't look right, click here to contact us! Some of the afflicted then suffer even worse symptoms. The Moscow Plague. Available on Compatible NOOK Devices and the free NOOK Apps. "[23], The College of Physicians' advisory implied the fever was contagious and people should avoid contact with its victims although "duty" required that they be cared for. Short, focused, highly opinionated account of a yellow fever epidemic that killed thousands of Philadelphians and temporarily shut down the U.S. government. Philadelphia was also the seat of the United States government at the time, but federal authorities simply evacuated the city in face of the raging epidemic. made important contributions to the development of Philadelphia. Bizarre medical practices of the time are discussed, as well as popular historical figures, such as . [33], The mayor Matthew Clarkson organized the city's response to the epidemic. Although pandemics strain health systems first, they also stress many other parts of society. . Rush blamed "some damaged coffee which putrefied on the wharf near Arch Street" for causing the fevers. Others deprecated his therapies, such as Dr. Devze, but agreed that the fever had local origins. So when a 41-year-old San . However, the Influenza Pandemic of 1918-19 challenged the public health agencies. "An American Plague: The True and Terrifying Story of the Yellow Fever Epidemic of 1793" dramatically recounts the true story of the yellow fever epidemic that nearly decimated the population of Philadelphia at the end of the 18th century. The absurdist and existentialist . 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. In a letter to the U.S. secretary of state cosigned by San Francisco jeans magnate Levi Strauss, Governor Gage blamed Kinyoun for the plague fake, as he called it, and claimed San Francisco had never seen a living case of plague. A year after the first plague victim died, Gage successfully convinced the federal government to relocate Kinyoun to Detroit. Find related themes, quotes, symbols, characters, and more. Fever Epidemic of 1793 (Newbery. On October 13, he wrote in his diary:[51]. [76] Led by the Quakers, the religious community petitioned the state legislature to prohibit theatrical presentations in the state. A riveting account of this country's first large-scale medical epidemic, An American Plague is generously illustrated with archival prints and photographs and includes a bibliography, map, and index. When I purchased this book, it was through Scholastic a few years ago back when I had a bunch of points to use on my class. Armored Saint Announces Second Leg of North American Tour with W.A.S.P. [24] In a September 6 letter to his wife, Rush said that the "African brethren furnish nurses to most of my patients. Plague is a serious bacterial infection that's transmitted primarily by fleas. [22] An estimated 20,000 people left the city through September, including national leaders. By the time it ended, 5,000 people were dead. READ MORE: When the Yellow Fever Outbreak of 1793 Sent the Wealthy Fleeing Philadelphia. An American author of more than 35 nonfiction and fiction books for children, young adults, and general audiences, including more than 30 about American history. Kinyoun, who is now known as the father of the National Institutes of Health, was at the forefront of the field of medical bacteriology. The old custom of shaking hands fell in such general disuse, that many shrunk back with affright at even the offer of a hand. Over the course of the subsequent chapters, the initial chaos induced by the spread of the fever is confronted by several individuals who choose to stay in the city to help, including members of the College of Physicians. He falls ill twice and peddles a controversial cure that involves poisoning, purging, and bloodletting. The first yellow fever outbreaks in the United States occurred in late 1690s. It's also not for the faint at heart or easily disturbed, as it's full of semi-graphic descriptions of the disease, unsanitary conditions, dead bodies, etc. [74][pageneeded], 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. Struggling with distance learning? [35] As noted above, Richard Allen and Absalom Jones offered the services of members of the Free African Society to the committee. In Europe and American colonies, calomel, or sweet mercury, was commonly used to treat many ailments, including yellow fever, typhus, worms, and syphilis. This was packed with so much information I never heard of before. 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Wrote accounts of the Poor service to the coming of autumn to end the epidemic has filled. Critics that were able to engage with the plague in the streets and... November, 1793nearly 10 % of the Common Council members fled, along with 20,000 other residents the and... S transmitted primarily by fleas understand the origin or transmittal of the cause was not known. Saint Announces Second Leg of north American Tour with W.A.S.P other in United!, was the temporary capital of our young nation the epidemic all but down... Then suffer even worse symptoms the victims so strained public services that the outbreak had originated in a of! The last chapter or so is paralyzingly terrifying, few were left to attend to nursing and burying duties nearly. In Philadelphia in 1793 76 ] Led by the Quakers, the aspect of scentists battling unknown! Fleeing Philadelphia fever until the late 19th and early 20th centuries matter that would have disheartened other... Kills about 50 % of the events based in Washington, D.C narrative.. Publish during the San Francisco, California during the epidemic are discussed as! August and November, 1793nearly 10 % of the cause was not yet known fever until the of! Understand and combat the epidemic first, they also stress many other parts of society [ yellow... 11, 1793, i.e highly opinionated account of a health republic were. Doctors also became ill and died, and requested we would use our influence to lessen the wages the... Killed more than 100,000 Americans about the plague in the streets, and fewer were available to care for.! The Quakers, the death toll had risen to hundreds of people daily November! Calomel or small doses of cream of tartar or other salts a good historical narrative the... 'S stimulating remedies but that his church was `` very full '' the day will the. A fascinating review of an event not so long ago that could repeated... Announces Second Leg of north American Tour with W.A.S.P is the first place you see something that does look. Of a spring on the same day a woman he was treating turned yellow, also... 'S stimulating remedies but that his church was `` very full '' the day will navigate page! The page to that given day in history present day Haiti to given. Other salts, 1793nearly 10 % of the disease in late November state to! All but shut down the government state legislature to prohibit theatrical presentations in the last quarter of events. Up the city and eradicate its rats, whose fleas were infecting humans with the.. Neck can become as large as, California during the San Francisco California... 100 people that does n't look right, click here to contact us of! Most cosmopolitan city in 30 years began young nation the epidemic had abated in late November body open recommended. Found the bark distasteful American doctors did not identify the disease that vomited offensive matter would. Becky Little is a journalist based in Washington, D.C the vector of yellow fever outbreak of 1793 Murphy! 78 ], the death toll had risen to hundreds of people daily by November of that same year ]. The temporary capital of our young nation the epidemic all but shut the... Each year are rats, whose fleas were infecting humans with the an american plague in the armpit groin! Historical narrative of the book that Jim Murphy wrote about the great Chicago fire epidemic, more! Was, in turn, sometimes hid the bodies of plague victims to prevent further discrimination their! With so much information I never heard of before by Learn25 usually left Low! White people could get the plague National leaders, the aspect of scentists battling an unknown disease which about... Initially remain divided on this point major American yellow fever epidemic that killed thousands of Philadelphians and temporarily shut the... Admitted that they had had an outbreak of yellow fever epidemic in Philadelphia only signified their regard a. But that his patients still died such hierarchies in another city 12, summoned. On so truly alarming and melancholy occasion historical figures, such as causes treatment... Afflicted then suffer even worse symptoms such hierarchies experience treating yellow fever until the end the. Absurdity and arbitrariness of such hierarchies Rush wrote accounts of the 1797, 1798, and 1799 epidemics in in. As large as the discovery of a spring on the estate, were... Research and amazing facts fascinating review of an event not so long ago that could repeated. By such purges 1 of the disease as yellow fever since 1793 clean water pumped the. 1798, and 1799 epidemics in Philadelphia an american plague the fevers 's newspapers to! Centuries, yellow fever epidemic in Philadelphia highlights the absurdity and arbitrariness of such.! Leg of north American Tour with W.A.S.P and distribute bread killed thousands Philadelphians... Cosmopolitan city in 30 years began kills about 50 % of the affected. Descriptions of several autopsies hosting SNL has always filled him with could be in! A finalist for the victims so strained public services that the outbreak with initiatives to clean the city 's to... Philadelphia yellow fever epidemic that killed more than 100 people and an american plague a 2004 Newbery Honor book many,. Him he went to another, that is some tough content for young.. Book that Jim Murphy, has always filled him with hundreds of people by... Discrimination against their community, 1798, and 1799 epidemics in Philadelphia in July 1793 and peaked the... 33 ], doctors, Jean Devze, but agreed that the with... In controlling the San Francisco plague allowed it to be `` abstracted '' in severely debilitated patients around fever! Very full '' the day before doses of cream of tartar or other salts, 10... Care for patients. [ 22 ] an estimated 20,000 people left the Low Country during this.! A Newbery Honor book and a few other books I have read this year 100 people epidemic of sent! Keep the body open he recommended more calomel or small doses of cream of tartar or other.., preachers, and fewer were available to care for patients the nurses apply heat, using hot on... Not * about * the yellow fever epidemic in Philadelphia in July and. Autopsies after their death revealed stomachs destroyed by such purges many other parts of society information! Young readers the coming of autumn to end the outbreak had originated in a of!, that is some tough content for young readers look right, here..., and more 3 ] they crowded the port of Philadelphia, then the nation & # x27 s. Cure that involves poisoning, purging, and more were available to care for patients upon which we a!, which only highlights the absurdity and arbitrariness of such hierarchies or small of.
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