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

When William Penn sent instructions to Thomas Holme, the surveyor of his new colony in North America, he asked him to select a spot for a “large Towne or Citty in the most convenient place upon the River for health and Navigation” (7). That emphasis on health would remain an essential concern among doctors, reformers, and city officials over the next hundred years, as Simon Finger shows in this history of public health in early Philadelphia. Finger’s effort, however, marks a significant departure from orthodox works on American public health, which have overwhelmingly depicted urban health measures as the more or less uncomplicated extensions of prevailing medical theories (ix). Instead, he reveals that health in early Philadelphia was a baldly political matter. Issues concerning the public’s health gave diverse groups opportunities to participate in civic affairs and secure their own interests; as a result, health policies and institutions reflected the myriad political, social, and economic concerns of both those who created them and those whom they affected.

Finger has divided his slender work into nine proportionately short chapters, which address pivotal episodes in the public health history of Philadelphia, from its foundation to the end of the eighteenth century. The first two chapters deal with the city’s founding. Eager to avoid the fate of London, which was struck by bubonic plague and then fire in 1665–66, Penn collaborated with urban reformers to plan a city that would preserve the collective health of its inhabitants, while also ensuring the continued viability of the colony as a whole. But he soon encountered the resistance of his own colonists, who refused to abide by sanitary regulations and building ordinances. Finger thus introduces a theme that he carries through The Contagious City: public health advocates consistently championed health as a means of securing the prosperity of city, colony, and nation; and their efforts consistently met with opposition from subjects and citizens, who resented interference in their daily lives.

In subsequent chapters, Finger discusses the travails of Philadelphians and colonial officials as they confronted the predictable health problems—overcrowding, poor sanitation, and disease—created by this growing commercial hub. Again, he repeatedly emphasizes that these health issues and their potential remedies involved much more than medicine. In chapter three, for example, Finger examines a fierce debate over a 1738 proposal for a lazaretto, or marine hospital, meant specifically to assist the growing number of German migrants entering Philadelphia. The debate pitted the proprietors in London, who supported the lazaretto as a way of gaining the electoral allegiance of the immigrants and thus enlarging their authority, against the Quaker majority in Pennsylvania, who objected to the high-handed intrusions from distant governors. The Quakers eventually came around and endorsed the lazaretto in 1743, but only after it had become clear that the Germans would bolster their antiproprietary stances in colonial elections.

Finger applies a similar critical approach to his discussion of the Pennsylvania Hospital, created in 1751 as a means of offering medical services to the poor. He contends that Benjamin Franklin, the hospital’s chief advocate, was motivated chiefly by a kind of “populationist” logic, through which he equated a large population of laborers with the health of the society as a whole (62). The hospital would dispense free medical aid to the poor, not just out of philanthropic motives, but as a means of returning them to their productive labors.

The key transitional moment in the history of Philadelphia public health, Finger argues, came with the American Revolution, which temporarily put an end to the networks of exchange that had linked American and British medical thinkers. Ultimately, the ordeals of war benefited such American doctors as Benjamin Rush, who returned with the optimism and experience to pursue a new vision of medicine that would usher in an era of healthfulness. Finger, though, detects a sinister, even Foucauldian, edge to their plans. With the creation of the College...