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

Simon Finger’s The Contagious City: The Politics of Public Health in Early Philadelphia traces the connections between politics and public health in Philadelphia from the seventeenth to the nineteenth centuries. The author does a fine job showing how political ideology corresponded with health and medical reform. Finger writes, “I . . . show how political efforts to promote health on a collective basis . . . shaped the political culture of that city and of the province and the nation around it” (5). He continues, “Ideas about people, politics, and space influenced the way colonists, rebels, and republicans conceived their polity” (6). As Philadelphia underwent colonial development, experienced revolutionary transformation, and exerted national influence, political leaders, medical professionals, city planners, and public health reformers did their best to positively influence the health of the city’s residents as well as the urban body politic.

Finger begins his study in the colonial period. He describes how William Penn promoted the physical transformation of the Pennsylvania landscape and fashioned Philadelphia’s layout. He hoped these measures might convince additional settlers to make the journey to his fledgling colony. He connected colonial power with demographic growth. As a result, he marketed his colony not only to residents of the British Isles, but also to Protestants in Europe. The decision to reach out to continental Protestants, specifically Germans, as potential settlers affected public health in several ways. Foreign migration, which was often accompanied by disease due to the tragic circumstances aboard ship, soon was seen as contagion. The association of the stranger with sickness brought about discrimination. Colonists wondered whether foreign bodies could be incorporated into the British body politic. Public health measures, including quarantine and the establishment of medical institutions, developed to help the ailing.

Philadelphia’s contributions to the Enlightenment also highlight the connections between politics and public health. Benjamin Franklin embodied the era’s devotion to association and improvement. He championed the Pennsylvania Hospital as a means of improving the well-being of the city and its ailing people. Philadelphians and other Pennsylvanians also participated in the Enlightenment exchange of knowledge. American colonists sent samples of all sorts to England and Europe for analysis and took advantage of the opportunity to study in cities, like Edinburgh, that led in medical education. Yet, as the political atmosphere in the colonies became inflamed by the revolutionary crises of the 1760s and 1770s, American medical students abroad united in the face of British condescension and heavy-handedness.

Finger also studies Philadelphia’s role in the Revolution and the early national period. He proves how “the war played a crucial part in transforming Philadelphia’s medical community” (86). Medical practitioners gained experience and prestige, associated with military and political leaders, and came to understand the significance of public health programs. Medical veterans of the Revolution continued to lead the city after the war. They founded the College of Physicians of Philadelphia, advocated for health reform, and contributed to city institutions like the dispensary. The yellow fever epidemics of the 1790s tested the power of these medical leaders and their political colleagues. Fear of the disease divided health professionals and even separated the new United States, as neighboring states feared the introduction of disease via trade.

The author completed an impressive amount of primary source research. He coupled archival manuscripts with published material and consulted documents from the seventeenth through the nineteenth centuries. Finger includes examples of visual primary sources, such as maps, a frontispiece, and a sketch, in his narrative so that the reader can see the connections between public health and politics.

Overall, the book works well. One weakness that detracts from Finger’s otherwise fine work is the author’s tendency to move quickly from one topic to another without adequate analysis. For example, after analyzing the incorporation of Germans into the Pennsylvania body politic, Finger abruptly discusses the forced resettlement of Acadians in Pennsylvania. His investigation of the...