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

Like several other historians and literary critics, Simon Finger analyzes Philadelphia as an urban laboratory. To studies of a Philadelphia “experiment” in religious toleration, town planning, representative government, citizenship, democracy, race relations, and freedom, Finger adds a lucid account of the influential role played by the city and its residents in struggles over how best to safeguard the collective health of the increasingly large and densely settled urban populations in the British North American colonies and then the early United States. He discusses the city’s prominent individuals—such as William Penn, Benjamin Franklin, Mathew Carey, and Benjamin Rush—but emphasizes populations and locations and the entanglements of medical discourse. Finger’s keyword is not experiment but constitution, a term with historical resonance (including the seventeenth-century English physician Thomas Sydenham’s “epidemic constitutions,” naming the local atmospheres conducive to particular diseases) and also overlapping somatic and political meanings. The term constitution signals relationships between parts and wholes, embodiments and abstractions. In Finger’s narrative, the debates about public health in Philadelphia involved the constitution of inhabitants, city, colony, nation, and empire.

In his meticulously documented and precisely argued book, Finger tells a story that begins with William Penn and Thomas Holme and extends to the early nineteenth century, when Philadelphia’s eminence diminished with the rise of New York City as the nation’s commercial and financial capital and the transfer of the political capital to Washington, DC. Finger resists narratives of extremity: “to focus solely on crisis moments is to tell an incomplete story” (x). Synthesizing an array of primary and secondary sources, he insists on detail and context. For example, he discusses the 1793 Philadelphia yellow fever epidemic, which has been given priority by literary critics, in relation to the city’s persistent vulnerability to disease (including several outbreaks across the eighteenth century) and to a century of debate about public health.

As an emblem of his approach, Finger in his introduction reproduces the 1777 map of occupied Philadelphia drafted by the British captain Pierre Nicole. In Nicole’s “Survey,” Philadelphia is a compact pink grid on the banks of the Delaware, surrounded by green fields—not the symmetrical and spacious vision outlined in Penn and Holme’s famous late-seventeenth-century plan, but an irregularly shaped tract, fortified against assault, tied to its agricultural backcountry and commercial waterways, part of a local but also an imperial economy.

In nine packed, relatively brief chapters, Finger describes efforts to imagine and actualize a healthier Philadelphia. He begins in the 1680s with William Penn’s scheme for a “‘large Towne or Citty in the most convenient place upon the River for health and Navigation’” (7), seeking an alternative to European cities such as London, which had suffered war, plague, and fire in 1665–66. Penn’s surveyor Holme relied on contemporary medical ideas, derived via Syndenham from Galen and Hippocrates, about the value of equilibrium, the balance of humors, and the influence of atmospheres on disease. In the second chapter, he shows how, in the early decades, landowners and settlers altered the plans for the city (for example, by subdividing lots and by carving out dens along the banks of the Delaware) and resisted Penn’s authority. Chapter 3 takes up the demographic shifts in colony and city, focusing on the influx of Germans in the first half of the eighteenth century and the arrival of Acadian exiles, who were French and Catholic, in the 1750s. These resettlements sharpened debates about how to care for strangers and protect against contagion (especially disease carried by ships), issues that became conspicuous in the struggle over the establishment of a lazaretto or marine hospital, used for quarantine. Finger shows how the disputes over the lazaretto revealed conflicting opinions about the identity of Pennsylvanians and the status of the colony in the British Empire.

In chapter 4, Finger considers the mid-eighteenth-century culture of reform in Philadelphia, including the divergent...