The Contagious City: The Politics of Public Health in Early Philadelphia

Preface

ix Preface When I began the work that would become The Contagious City, I was trying to solve a problem of collective action: How do communities respond to shared dangers? I did not want to plow the well-furrowed ground of IndianEuropean conflict or imperial rivalry, and after some consideration I realized that disease presented a threat that easily rivaled tomahawk and musket ball. Although colonial planners and settlers shared a sense that disease was a common hazard and health a common goal, they differed dramatically in their understanding of how best to confront contagion and promote wellness . Few colonies illustrate that rift so vividly as Pennsylvania. The dream of protecting health on a collective level molded its capital at Philadelphia and the settler empire that took shape in North America. Colonial, provincial , and national societies all depended on the creation and mobilization of population to create a community and fuel an economy. The battle over public health was a keystone to the politics of empire, but it has not always been understood as such.1 Until the middle of the twentieth century, American medical historiography was largely dominated by an antiquarian bent and pointedly apolitical perspective that encompassed both general surveys and local case studies.2 Even thereafter, many works continued to isolate medical development from wider social currents, although works by Whitfield Bell and Charles Rosenberg, among others, began to integrate American medicine with its social context.3 Meanwhile, W.B. Bynum, Roy Porter, and fellow British scholars recovered stories of the medical enlightenment that restored its political content. Adrian Wilson has referred to this scholarship as history of medicine with the politics put back in.4 Orthodox historians of American public health have focused almost exclusively on the development of formal institutions of sanitation and public relief. Although this literature has allowed for a modicum of institutional development in the colonial era, and even offered a political framework for its emergence, scholars have generally interpreted these measures as moments x Preface of exigent improvisation in response to particular crisis episodes.5 This has led many to downplay development before the mid-eighteenth century, and some go further still, effectively dismissing the existence of “public health” prior to Edwin Chadwick’s campaigns for sanitary reform in nineteenthcentury England. Whatever their chronology, these accounts almost universally treat American public health as a creole response to colonial conditions: increasing density and urbanization in the colonies.6 To focus solely on crisis moments is to tell an incomplete story. Responses to disaster did not arise ex nihilo, but from a deep pool of preexisting ideology and experience, just as an army’s responses in wartime are shaped by its peacetime practices. Similarly, those responses did not just happen, but rather went through channels of established political practice, demanding that priorities be set, interests satisfied, and choices made. Medical thinkers and political leaders had a positive program to promote collective health, and they connected that program to larger political, social, and economic interests.7 Almost entirely separate from this work on institutional medical development , scholars of the body and the environment have offered a rich portrait of how American settlers understood the relationship between the two and how that understanding affected colonization. Transplanted Englishmen feared that they would undergo atavistic degeneration in their alien surroundings , even as they hoped that they could cultivate that landscape into a healthier state, more like their agrarian English homelands.8 Even after independence, Americans who transplanted beyond their cultural and political comfort zones displayed a similar anxiety that soil would win out over blood, unless blood could tame the soil.9 Creating a healthy population depended on reproducing familiar forms imported from home. Adopting a Foucaultian perspective, subsequent scholars reinterpreted the development of public health infrastructure as an instantiation of hierarchy and the individual institutions as mechanisms for enforcing conformity to a rigid social vision organized around a disciplined capitalistic modernity.10 Along with revisionary works on the body, health, and hygiene, these efforts offered a sophisticated new vocabulary for explaining the relationship of health to race, gender, politics, environment, culture, and more. At times, however, political calculation almost seemed to crowd out health entirely, consigning philanthropic and medical reform to the status of mere pretext for more cynical designs for power and control. In The Contagious City I situate the existing scholarship on public health in early America within the interpretive framework of population. Students of migration and social history have long acknowledged the importance...