Pandemics and Economics in History #11

Episode #11: Health, medicine, and politics in disease outbreaks

Pandemics and Economics in History, Episode #11: Health, medicine, and politics in disease outbreaks

Several outbreaks of yellow fever occurred in Philadelphia during the period when the city served as seat of the United States government, from 1790 to 1800. Common theories of infection at the time involved “bad air” or “miasma,” on the one hand — known as the Climatist theory — and contact between humans, or the Contagion theory, on the other. Medical science was still a century away from understanding that yellow fever, a serious, potentially fatal, viral infection was spread by mosquitoes. This made yellow fever — just one of the many potentially deadly illnesses people then regularly faced — particularly confounding and frightening. Philadelphia’s experiences with yellow fever were one driving force in moving the U.S. capital to the land of Anacostan or Nacotchtank people, later the Piscataway, on which Washington DC now sits.

Although the link between yellow fever and mosquitoes was not known, links between water — which, of course, can be breeding grounds for mosquitoes — and the disease were suspected. So, one result of the yellow fever outbreaks in Philadelphia was construction of the first major municipal water system in a U.S. city.

Historian Carl Smith wrote about water and urban life, discussing Philadelphia’s yellow fever outbreaks in his 2013 book, City Water, City Life: Water and the Infrastructure of Ideas in Urbanizing Philadelphia, Boston, and Chicago. Much of the book is about sanitarian, temperance, and other philosophies of social welfare. But Smith also focuses on specific projects around water. He writes:

A series of health catastrophes, and the fear of more to follow, convinced Philadelphians to erect the first truly comprehensive waterworks system in a major American city. During the summer and early autumn of 1793, yellow fever killed an estimated five thousand people, or about 10 percent of the residents of Philadelphia and adjoining towns. Close to half the citizenry, including President George Washington… literally ran for their lives, fleeing the death-haunted metropolis for the surrounding countryside. Yellow fever revisited Philadelphia in four of the next five summers; the devastation and panic in 1798 were comparable to five years earlier.

In 1797 “an unprecedented number of the most respectable citizens of Philadelphia” petitioned the members of the city’s Select Common Councils (referred to collectively as the Counils), imploring them, “as Fathers of the City, as Guardians of the Poor, and the health and p rosperity of their Fellow Citizens in general,” to authorize the construction of a water supply that could be used to cleanse the city and, presumably, its susceptibility to the fever….
— Smith, p.14

The Mother of Invention

This is the part of the book emphasized in a recent publication of the American Society of Civil Engineers. In “First of Its Kind: The Philadelphia Municipal Water Supply,” we read:

There had been other water systems in America before Philadelphia’s — Bethlehem, about 70 mi north of Philadelphia, had installed a rudimentary water supply system some 50 years prior. But Philadelphia’s was the first at a large (for that time), municipal scale. And Philadelphians themselves had strong opinions about the need for such a system….”

But it took the yellow fever outbreaks for the city to create the Joint Committee on Bringing Water to the City, which issued a report in 1798 calling for a new water supply to mitigate the risk of illness. To oversee the system, the city turned to English-born American architect-engineer Benjamin Henry Latrobe, who was in Philadelphia building the Bank of Pennsylvania, the earliest work of neoclassical architecture in the United States.”
— “First of its Kind,” ASCE

In addition to describing the steam engines and other technology involved, Witcher notes that the funds were raised “by selling shares of the water itself, an early form of user fees.” He also explores more interactions between engineering and financing and some connections between architecture and engineering.

Innovations in supplying municipalities with clear water are important consequences of the Philadelphia yellow fever outbreaks. But, of course, water works are only one of many sets of consequences. And many conflicting sets of ideas were at work in the financing and construction of the Fairmont Waterworks.

Some of these are explored by Simon Finger, a historian who focuses on early American history and the social history of medicine, writes about interactions of politics and ideas of public health.

Nothing from Nothing

In 2012, Finger published Contagious City: The Politics of Public Health in Early Philadelphia. Early on in this book, he makes the following point:

To focus solely on crisis moments is to tell an incomplete story. Responses to disaster did not arise ex nihilo, but from a deep pool of preexisting ideology and experience, just as an army’s responses in wartime are shaped by its peacetime practices….
— Finger, p.x

Finger describes how basic notions about bodies and land or soil, as well as ideas about empire building, influenced decision-making around public health in early U.S. history, particularly in Philadelphia during its capital years. And he reports that he began working on the book as an attempt to “solve a problem of collective action: How do communities respond to shared danger?”

In an on-line entry in the Encyclopedia of Greater Philadelphia, Finger summarizes one aspect of his research into the fellow fever outbreaks in that city:

Each episode spurred similar patterns of evacuation, isolation, and scapegoating, and stoked the ongoing controversy within the medical community and motivated broader, though futile, efforts to ameliorate the effects of the disease. Nursing may have offered some comfort, but only winter frost—and its extermination of the mosquitoes—brought an end to each fever year.
— “Yellow Fever” IN Encyclopedia of Greater Philadelphia

A future podcast will explore this pattern further and at the various philosophies at work. In addition, we’ll look at other perspectives on this tale.

Much was written about the yellow fever outbreaks at the time. Some of that material is still available and will appear in a future podcast. A great deal of scholarship has focused in the ensuing 200 years on public health, politics, and the intersection of the two in this story. Within the last year, many have noted parallels between Philly in the 1790s and various aspects of our country’s situation today.


Finger, Simon. Contagious City: The Politics of Public Health in Early Philadelphia. Ithaca, NY: Cornell University Press, 2012.

Yellow Fever” IN Encyclopedia of Greater Philadelphia

Smith, Carl. City Water, City Life: Water and the Infrastructure of Ideas in Urbanizing Philadelphia, Boston, and Chicago. Chicago: The University of Chicago Press, 2013.

Witcher, T. R. “First of Its Kind: The Philadelphia Municipal Water Supply.” Jan/Feb 2021 Civil Engineering. ASCE

See also:

Public Health” by James Higgins IN Encyclopedia of Greater Philadelphia

11 Things You Might Not Know About Philly’s 1793 Yellow Fever Epidemic” in Philadelphia Magazine (2011).

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