In March of 2020, the concept of “quarantine,” once seemingly on the fringes of American culture, entered mainstream discourse. As the world was shutting down due to the exigencies of the COVID-19 pandemic, David Barnes, associate professor of the history and sociology of science at the University of Pennsylvania, was studying the long history of quarantine in the City of Brotherly Love. The result is Lazaretto: How Philadelphia Used an Unpopular Quarantine Based on Disputed Science to Accommodate Immigrants and Prevent Epidemics. By focusing on a single site, the Lazaretto quarantine station south of Philadelphia, Barnes’s scholarship offers a compelling exploration of the political and medical history of quarantine during the nineteenth century. In so doing, he recovers the overlooked story of a Philadelphia institution and simultaneously places Americans’ COVID-19 experience, and indeed American public health, in historical context.The book is organized chronologically, providing a detailed narrative that traces the evolution of the Lazaretto’s operations from its establishment in the first months of the nineteenth century through its decline and closure ninety-five years later. Beginning with the yellow fever epidemic of 1793, Philadelphians experienced four disease outbreaks over the course of six years. Looking to protect themselves against future epidemics, while maintaining their strength in commercial shipping, construction began on a new quarantine station in 1799 on remote Tinicum Island, 13 miles south of the port of Philadelphia. The Lazaretto, the name of which derived from Lazarus, the patron saint of lepers, opened for business in April 1801 and would operate for almost the entirety of the nineteenth century, as global trade expanded, and America experienced vast changes in medical knowledge.At its core, this book is about politics, particularly the balance of individual rights and collective welfare. The Lazaretto was not always popular; Barnes captures this sentiment, arguing that the dilemma that created the Lazaretto, and was present throughout its life was: “How can we make ourselves safe from epidemics while still carrying on with our lives?” (238). For Philadelphians, the primary concern swirling around the Lazaretto was how to maintain robust shipping commerce while simultaneously protecting the health of the city—two poles that were frequently at odds. The quarantine station was managed by a Board of Health, consisting mainly of appointed or elected civic leaders, augmented by a minority of physicians. This group oversaw measures at the station, while also waging a public relations battle to convince the populace of the surrounding area that the station was necessary and making a difference in public health. While not universally successful, with some major epidemics breaking through the Lazaretto’s safeguards, Barnes asserts that overall, quarantine practices played a crucial role in protecting Philadelphia’s urban population.Secondary to the political aspects of the Lazaretto are the medical practices of quarantine. Throughout the book, Barnes explores how shifting medical paradigms—from miasma theory to germ theory—shaped quarantine practices and public reactions to disease. In the early years of the Lazaretto’s operations, physicians were still unsure of how disease spread. One camp advocated contagion, while the other believed in spontaneity. The solution was to placate both sides by focusing on the disinfection of vessels and cargo and the treatment of ill people. Physicians at the Lazaretto were successful in providing supportive (palliative) care to help fight disease and Barnes is quick to note that “the vast majority of Lazaretto patients were cured emphasis original” (135). And, of course, as the nineteenth century progressed, germ theory became more widely accepted. Indeed, one of Barnes’s most provocative arguments is that the Lazaretto’s ultimate decline stemmed from its effectiveness. As disease incidence decreased, public and political support for quarantine measures waned, leading to underfunding and neglect. This paradox, Barnes suggests, is a recurring challenge in public health: success often breeds complacency.Barnes’s methodological approach intertwines narrative history with analysis, making the work accessible while maintaining scholarly rigor. He draws extensively on newspapers, archival documents, and both primary and secondary sources to construct his argument, presenting a richly textured account of how quarantine policies intersected with broader social, political, and economic dynamics. He focuses on the stories and experiences of a wide cross section of people—politicians, seamen, physicians, nurses, and support staff—who were brought together around the Lazaretto. In so doing, it reminds us that these were real people, whose lives were affected by the decisions they made at this station. “Day after day, year after year,” Barnes writes, “behind the scenes labor by unseen and unsung men and women made the Lazaretto work” (179).While Lazaretto is richly detailed and compelling, the narrative’s scope sometimes makes it difficult to follow. This is not surprising, as the author is attempting to cover more than one hundred years of history in 250 pages. Historical actors flit in and out of the narrative, making it sometimes difficult to remember who is who. Another limitation is the book’s relatively narrow geographic focus. Although Philadelphia serves as an excellent case study, readers might wish for a comparative perspective that situates the Lazaretto within national or global trends in quarantine practices.David Barnes’s Lazaretto is a masterful blend of narrative history and scholarly analysis. And, of course, this book is particularly timely given recent global experiences with pandemic responses. Barnes’s exploration of public resistance to quarantine, debates over government overreach, and the moral complexities of enforcing public health measures offers valuable historical context for understanding contemporary crises, from COVID-19 to ongoing debates about vaccination mandates. He confesses that “the long history of quarantine has never not emphasis original been controversial” (8). By shedding light on the complexities of quarantine as both a practice and a symbol, Barnes enriches our understanding of public health’s past and its enduring challenges. The book will find a home on the shelves of historians, public health scholars, and policymakers grappling with the delicate balance between individual rights and collective safety.
Peter Miele (Thu,) studied this question.