The Contagious City: The Politics of Public Health in Early America by Simon Finger (review)

Simon Finger's The Contagious City is the engaging historiography of a city wracked by the twin dangers of disease and political rivalry. With each new health crisis Philadelphians found themselves stuck in the interstices of "prosperity [and] annihilation," which inspired political ingenuity to resolve (146). Comprehensive yet streamlined, The Contagious City thoughtfully surveys the history of public health, which Finger localizes in Philadelphia and situates at the intersection of medical, environmental, and political history.

Finger argues that the constitutions of Philadelphia and its residents were mutually constitutive from the colonial period into the nineteenth century, the era of health reform that has attracted the most scholarly attention. In planning Philadelphia, William Penn envisioned a space that would nurture the minds, spirits, and bodies of the populace—to facilitate sound constitutions for all its residents. According to seventeenth- and eighteenth-century Galenic principles of human physiology, a body's physical constitution, or humoral balance/imbalance, was influenced by interaction with the built or natural environment. Urban dwellers were threatened by moral and physical degeneration, which caused an imbalance in the bodily humors (i.e., blood, phlegm, yellow bile, and black bile), thus weakening their constitutions and making them vulnerable to disease (10).

For Finger, the politics of public health was shaped by efforts to achieve a balance within the city's "humors" or influences. Through policies and institutions, administrators of public health sought a balance between individual and community needs, between guarding and growing the population, between humanitarian and economic interests. As Finger argues, "Equilibrium was essential to their sanitary calculus" (155); however, like achieving balance or equilibrium in a body's constitution, keeping Philadelphia's interests and objects balanced required maintenance and negotiation when new hazards to the equilibrium were introduced.

In observing the pattern of public health in Philadelphia from its origin as a would-be Quaker capital to a commercial, cultural, and even national capital, Finger observes the use of health as a flexible political tool, helpful in establishing a communal identity and implementing policies (6). By the early eighteenth century, Philadelphia had dramatically changed in population and appearance. Due to increased population, poor sanitation methods, crowding, and the constant arrival of ships ferrying new disease-causing microbes, a healthy constitution was increasingly harder to obtain (57). Emerging health risks gave rise to efforts and institutions that comprise a general understanding of the term "public health" that Finger understands as always already political. For instance, the flux in immigration and trans-Atlantic trade made it necessary to implement quarantine laws, establish lazarettos (quarantine hospitals specifically for maritime travel), and engage medical/political officials to oversee it all. Philadelphians feared and resented newcomers who brought diseases ashore from their ships; to these inhabitants, the lazaretto represented danger (35). To popular and proprietary politicians, however, new arrivals meant potential voters who could be useful in their disputes over control of the colony.

Not all of Philadelphia's public health conflicts concerned the confrontation of difference as immigration and import did. The clearest example, by Finger's own estimation, for "understanding the clashing ideologies of health and public action" is the establishment of the Pennsylvania Hospital in 1751 (60). A free hospital modeled after British voluntary hospitals, the Pennsylvania Hospital was "a haven to relieve the city's sick" (59). However, Finger explains an equally significant purpose of the hospital: situating Philadelphia in an international network of medical science. As a draw to European doctors and medical students, the hospital would bring the city financial benefits and notoriety from international medical travel. There was no way to equally service the bodies of the poor and minds of the rich, but the effort fueled debates between Benjamin Franklin and Thomas Bonds, among others.

Subsequent chapters of The Contagious City address the emergence of the physician as a political figure even as he doctored...