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

The Contagious City is a well-written account of concerns with public health in Philadelphia from initial plans for its establishment in the 1680s through its position as the scientific capital of the new republic circa 1800. While much of this will be familiar to historians of medicine, Simon Finger’s focus is on the interrelationships between approaches to public health and to political order. As such, his work serves as much as an introduction to urban history and to colonial and early national politics as it does to the history of medicine in this period.

As Finger demonstrates, ideas about both public health and political order showed strong continuities over the course of the eighteenth century. One major sustained concern was the relationship between the environment and bodily health; a second was the tension between localist and geographically wider political commitments. William Penn’s original vision was that Philadelphia’s spatial layout would prevent its degeneration into the filth and disease that characterized cities like London, and that his benevolent political control would promote both a healthy and a harmonious polity. Actual immigrants, however, crowded the waterfront, and recalcitrant colonists pursued their own interests. These tensions played out in subsequent decades, most notably in struggles over immigration and quarantine. Penn’s heirs continued to encourage a pan-Protestant migration, believing that a growing population would enhance the security and prosperity of the colony and thus strengthen not only Pennsylvania but the British Empire overall. To that end, they supported such policies as the establishment of a marine hospital to care for the shipboard sick. Their efforts met with determined local resistance by Philadelphians who saw the influx both of strangers and of disease as threats. By midcentury, ideas about the value of sociability and of improvement circulating in the wider Atlantic world were manifested in Philadelphia by the establishment of the Pennsylvania Hospital. Brick homes and paved streets, responses both to new values and to private pressures like access to fire insurance, altered the built environment of some areas of the city even while political efforts to clean up noxious trades (like butchers) were ineffectual against other private interests. Experiences during the Revolution then greatly reinforced beliefs about the relationships between health and environment, and between health and political order. Medical personnel exposed to the early disorder and disease of army camps and the subsequent disciplining of such camps emerged from the war even more strongly committed to the transformative effects of intertwined environmental, bodily, and moral improvement. However, the particularly virulent outbreak of yellow fever in 1793 wreaked havoc not only on Philadelphians but on the newly achieved prestige of Philadelphia physicians. Doctors were divided about the cause of the disease (the “climatists” attributing the epidemic to a combination of corrupted air and weakened bodies, the “contagionists” arguing for an infectious agent). They disputed heatedly about solutions, and both sides lost credibility. Yellow fever, then, showed Philadelphians continuing to struggle with understanding the links between the environment and human health. It also was the site of yet another struggle between localist and extralocalist politics. Philadelphia responded to yellow fever by increasing the rigor of its ship inspection and quarantine procedures, while its neighbors (and economic rivals) were more lax. Interestingly, Philadelphians generally opposed efforts to shift responsibility for quarantines to the federal level, arguing for a vision in which the public was best protected by a vigorous, locally controlled government.

One original thread in Finger’s account is his attention to populationist concerns, such as Penn’s heirs’ focus on population numbers as crucial to defense and prosperity, the Pennsylvania Hospital’s preferential focus on returning laborers to productivity, and the Revolution’s role in getting physicians to think in terms of the health of populations, instead merely of individuals. While this was the explicit concern of only a handful of people, it was a...