Public Health in Cities in Historical Perspective
On Thursday, November 16th, the Albert Lepage Center for History in the Public Interest hosted Dr. Andrew Wehrman (Central Michigan University), Dr. Cindy Ermus (UTSA), and Dr. David Barnes (UPenn) for a virtual panel discussion exploring public health in cities in a historical perspective. The panel was moderated by VU History Professor Dr. Julia Mansfield.
Watch a video recording here: https://www.youtube.com/watch?v=G5h1Rxczaes&list=PL_Z9mt0HJesnqXQRRe8bYlPcFpOOi6KTc&index=3
On November 16th, The Albert Lepage Center for History in the Public Interest hosted Dr. Cindy Ermus, Dr. David Barnes, and Dr. Andrew Wehrman for a panel discussion on public health in American cities. The panelists addressed historical epidemics in cities, analyzing their devastating effects and how cities’ populations responded to them. Through these presentations, the speakers led a dialogue about public health’s effects on civilian and government dynamics and political engagement, the balance of local and central government, and the development of new health protocols in emergency situations.
Dr. Ermus started the discussion by presenting her book The Great Plague Scare of 1720, which covers the 1720 outbreak of the bubonic plague in the Provence region of France. This outbreak was one of the last large outbreaks of the plague after it devastated Europe for almost 400 years. The plague arrived in France in 1720 on a ship called the Grand Saint Antoine that brought silks and luxury items to Marseille in the Provence region, killing as many as 126,000 of Provence’s 600,000 inhabitants. Despite the plague’s destructive nature, Dr. Ermus emphasized how Europe’s increasingly centralized national governments benefitted from the circumstances surrounding the epidemic in 1720 Provence.
The 1720 plague outbreak occurred during a time in Europe where crises were beginning to be managed by the central governments of the continent’s emerging nation states. Prior to this, crises had been managed on a much more local level, inspiring Dr. Ermus to study the epidemic’s effects on cities in and around Provence like Marseille and Paris in France, the Italian city-states of Genoa and Venice, London in England, and Cádiz in Spain. The heads of state of these nations and city-states opened unprecedented levels of communication to coordinate efforts to contain the plague’s spread. This led to public health developments like health certificates, health passports, detailed quarantine directions, and quarantine lines. At the same time, increased surveillance and centralization of power led to reduced smuggling, trade embargoes, ship searches and the foundation of central health boroughs to manage crises. These developments empowered the central governments of France and other western European countries, demonstrating the validity of central legislation during a period where local government was powerful.
Dr. Ermus’s research revealed how central governments used the 1720 Provence plague outbreak to centralize public health power. Consequently, the development of centralized public health measures allowed national governments to bolster their power and influence over local governments.
Dr. Wehrman presented on his book The Contagion of Liberty: The Politics of Smallpox in the American Revolution, which covers how the smallpox epidemic during the American revolution inspired political discourse in 18th century America. Like Dr. Ermus, Dr. Wehrman argued that the Smallpox epidemic modified American politics during the 18th century: Unlike Dr. Ermus, Dr. Wehrman’s analysis of the Smallpox outbreak outline how engagement with public health measures increased during the American Revolution, empowering individual public health engagement.
According to Dr. Wehrman, a slave named Onesimus first discovered inoculation in 1721, introducing one of the most important public health developments in history. During the American Revolution 50 years later, Americans demanded inoculation against the devastating Smallpox outbreak occurring at the time, with George Washington famously inoculating the Continental Army in 1777. In cities like Charleston, South Carolina, public health measures like quarantines were instituted, and the people of the time saw these measures as a protection of their health rather than an infringement of liberty like some modern Americans would. In cities like Boston, the entire city would be quarantined to allow its citizens to be inoculated, while the national stance on inoculation became one of widespread acceptance. As a major development in public health, the burgeoning nation embraced the procedure, and Dr. Wehrman argued that liberty is a collective right, not an individual one. This argument effectively claims that liberty is not meant to be a right to act however one pleases; instead, it is the freedom to act for the general good without sustaining the ire of a ruler or facing legal ramifications.
Like Dr. Ermus, Dr. Wehrman argued that epidemics influence the political structure of affected cities. However, Dr. Wehrman’s discussion addressed the role of liberties surrounding public health measure instituted by a central government, asserting that public health directly inspires people to act for collective betterment alongside the government instead of at the will of their government. At the same time, Dr. Wehrman argued that this principle makes it the duty of the government to ensure the health of its people during times of catastrophe.
Dr. Barnes ended the discussion by presenting on his book Lazaretto: How Philadelphia Used an Unpopular Quarantine Based on Disputed Science to Accommodate Immigrants and Prevent Epidemics, which tells the stories of survivors of the Lazaretto, a quarantine station built on Tinicum Island (an island downriver from Philadelphia’s port) as a response to yellow fever epidemics in the 1790s. Throughout the 19th century, the Lazaretto was used to strictly enforce quarantines. Dr. Barnes focused on how the Lazaretto was controversial at the time, but modern historians like himself use firsthand accounts of the care provided at the Lazaretto and its effect on the citizens of Philadelphia and the mass of immigrants that came to the city in the 19th century to analyze its role in public health history.
In the late 18th and early 19th century, immigrants came to the United States (many from German-speaking nations) en masse, enticed by promises of easy wealth. However this brutal system involved confiscating these immigrants’ possessions as they were crammed into filthy cargo holds rife with disease. They were quarantined and then indentured to pay for their transport. Thousands of immigrants and sailors came to the Lazaretto, arriving at the station sick with either yellow fever or typhus, two frequently fatal diseases. Records from the Lazaretto show that the station had a staggeringly high 88% survival rate, unprecedented for the time.
While the history of the Lazaretto is plagued by numerous examples of incompetent leadership, Dr. Barnes praised the leadership of William T. Robinson, a Lazaretto physician from 1878 to 1883. Robinson skillfully reassured city leadership and the public while navigating a yellow fever crisis, containing the spread of the disease while stopping public panic. Robinson serves as an exemplar of public health leadership, containing the spread of a disease for the betterment of the collective, much like the collective responsibility Dr. Wehrman valued during his presentation.
Dr. Barnes told the story of a quarantine station rather than looking at the wide-scale ramifications of a singular epidemic like Dr. Ermus and Dr. Wehrman. However, the Lazaretto played a focal role in the development of Philadelphia, serving as a staging ground for the large immigrant population that earned America its title as a “melting pot”, comprising many of the people who still inhabit modern day America. Despite this smaller scale discussion when compared to Drs. Ermus and Wehrman, Dr. Barnes’s analysis of the Lazaretto offered valuable insights into the early development of American public health in one of the most historically significant American cities.
Epidemics are powerful and devastating, but their public health responses can be constructive politically and economically. Dr. Ermus’s presentation on the Provence plague outbreak of 1720 demonstrated how western European nations centralized power to facilitate crisis management, and this also allowed these nations bolster their central governments’ power over local governments. Rather than looking at the effect of the 18th century American smallpox epidemic on the American federal government, Dr. Wehrman used it as a framework to interpret personal liberties. In revolutionary America, these liberties mobilized civilians to seek inoculation, setting a precedent of civilian mobilization for the institution of public health measures in public health crises. Dr. Barnes’ presentation addressed the role of well-organized public health infrastructure and how it aided America’s burgeoning population. Through revolutionary sanitation and quarantine methods, the Lazaretto stands as a monument to public health in Philadelphia, facilitating population growth by ensuring the survival of countless immigrants in the 18th and 19th centuries. Epidemics are destructive, but all three speakers demonstrated how public health crises have historically facilitated development on a local and national level.
Book Links
Dr. Ermus — The Great Plague Scare of 1720: https://www.amazon.com/Great-Plague-Scare-1720-Eighteenth-Century/dp/1108489540/ref=sr_1_1?crid=29PZ82Y9JN5AV&keywords=great+plague+scare+of+1720&qid=1705525213&sprefix=the+great+plague+scare+of+%2Caps%2C202&sr=8-1
Dr. Wehrman — The Contagion of Liberty: The Politics of Smallpox in the American Revolution: https://www.amazon.com/Contagion-Liberty-Politics-Smallpox-Revolution/dp/1421444666/ref=sr_1_1?crid=1JU0KPCJWJEN2&keywords=The+Contagion+of+Liberty%3A+The+Politics+of+Smallpox+in+the+American+Revolution&qid=1705525416&sprefix=the+contagion+of+liberty+the+politics+of+smallpox+in+the+american+revolution%2Caps%2C140&sr=8-1
Dr. Barnes — Lazaretto: How Philadelphia Used an Unpopular Quarantine Based on Disputed Science to Accommodate Immigrants and Prevent Epidemics: https://www.amazon.com/Lazaretto-Philadelphia-Quarantine-Accommodate-Immigrants/dp/1421446448
