David Barnes, Associate Professor of History and Sociology of Science at the University of Pennsylvania and activist for the preservation of Philadelphia’s Lazaretto, provides us with the first comprehensive account of the oldest quarantine station in the United States. "Lazaretto: How Philadelphia Used an Unpopular Quarantine Based on Disputed Science to Accommodate Immigrants and Prevent Epidemics" is a fastidiously researched history of quarantine that takes its readers from the “Athens of America” in the 1790s to “The Workshop of the World” in the 1890s.

The Lazaretto, as quarantine stations were often called from the Italian diminutive form of Lazarus, the patron of lepers, is another historic example in Philadelphia’s illustrious list of firsts in the United States. The centerpiece of Barnes’ monograph is the newly built quarantine station on Tinicum Island, 13 miles downriver from Philadelphia, in 1801. The station was erected as a response to the four yellow fever outbreaks in the interim U.S. capital in the last decade of the 18th century, which cost thousands of lives, diminished the economy and led in 1798 to the per capita “largest urban exodus in American history” (p. 14). A new system of quarantine needed to be established to save the Early Republic’s metropolis as a prosperous as well as a simply habitable urban center. David Barnes tells this particular history of quarantine through a variety of themes and perspectives in three parts: (1) Struggling for Survival (1793–1803), (2) Managing the New Normal (1804–1847), and (3) Crisis, Statesmanship, and Decline (1853–1895) supplemented by an account of the station’s various afterlives. The first part is clearly dedicated to the various yellow fever outbreaks and the differing quarantine policies and practices in their response, whereas the second part focuses largely on several German and Irish immigrants’ stories and the linkage between disease, famine, profit and human trafficking. In addition, the third and final part illustrates the changing perceptions of disease and quarantine as well as the restructuring of public health in the United States.

Barnes’ monograph is foremost a history of quarantine paradoxes: control vs. uncertainty, freedom vs. unfreedom, protecting vs. hurting human life and the economy, creating a vacuum vs. never taking place in a vacuum. Quarantine was an unpopular public health tool that affected the whole population and was implemented by every major Northeastern U.S. seaport in the century of Philadelphia’s Lazaretto. Quarantine policy was firmly based in law; however, its success was determined by the people’s trust (p. 55). David Barnes illustrates how an epidemic was and is not merely a medical but also a social disease. Thus, an effective regime of quarantine relied on vigilance, transparency and trust in order to combat fear, falsehood and flight in times of uncertainty (p. 85). "Lazaretto" is also a history of freedom, especially in terms of mobility, and the inherent paradox of liberty: “In quarantine, denial of freedom actually made freedom possible” (p. 67). Moreover, quarantine was a measure to save the economy, but strict quarantine practices led to delayed goods, closed-off warehouses, and detained ships. Profit and greed oftentimes also trumped humanity during the waves of “voluntary” immigration in the early and mid-19th century. "Lazaretto" vividly describes different immigrant stories and transatlantic voyages on “human herring boxes” (p. 72) and “floating coffins” (p. 125) that were the ideal breeding grounds for ship fever, later known as epidemic typhus. While David Barnes focuses on the story of the Philadelphian Lazaretto, he often indicates the intertwined nature of quarantine policy by illustrating the entanglement with other American cities in epidemic prevention as well as the effects of an increasingly globalized world through transatlantic exchange of goods, people, and diseases (e.g. p. 81). "Lazaretto" is however also a story of hope and humanity, as the Lazaretto hospital had an impressive survival rate of patients who were treated for incurable diseases (p. 135). Barnes focuses on the success of taking care of other human beings and the positive outcomes of what he calls “care cure” (p. 179). He argues for a refocus on care for disease prevention and governing human beings which fits into the care paradigm of Joan Tronto’s “Caring Democracy” or Deva Woodly’s approach of “Politics of Care”.1 Moreover, David Barnes takes us not only into the world of the Lazaretto on the Delaware riverfront, but also onto the docks and streets of Philadelphia’s “infected district” and into the municipal court rooms where violations of quarantine laws were being negotiated. He additionally sketches the progress from a patchwork of state and municipal legal acts to a nationwide public health regime including the passing of the National Quarantine Act in 1878 and a new network of federally run quarantine stations, which eventually led to the closure of the Lazaretto in 1895. As the “self-appointed evangelist of the Lazaretto” (p. 231), David Barnes concludes his monograph with the manifold afterlives of the quarantine station, amongst others serving as a seaplane base and marina, in addition to the struggle of engaged citizens to preserve the Lazaretto as a historic site, which ultimately led to its restoration in 2016.

David Barnes’ monograph is rich in detailed source material and its compellingly nuanced and careful application thereof. "Lazaretto" is a stimulating piece of work by a skilled writer and historian displaying a sensitivity to discourse, explicitly acknowledging the meaning of words of their times (e.g. p. 143), being frank about the existence of mixed accounts in source material, and indicating suggestive not absolute numbers of surviving records (e.g. p. 139, p. 144). Furthermore, Barnes’ monograph is also exceptionally vivid due to the use of diverse lithographs as well as photographs – 26 illustrations in total – in addition to various maps (p. 159, p. 178, p. 189) and info-boxes about yellow fever and typhus (p. 17 and p. 47). "Lazaretto" is a joy to read and an engaging experience for readers of a wide field of interests. It is an intersection of several historiographies, foremost social and medical history, but it branches out to include political, legal, economic, urban history and history of science as well. David Barnes includes at times even a history of the present by linking his research to the Ebola epidemic (pp. 145–147) and the COVID-19 pandemic (pp. 238–240). "Lazaretto" is a very useful work for a variety of scholars in those different fields and adds to various scholarships, for instance as a geographic and chronological counterpart to J. Gordon Frierson’s "Guarding the Golden Gate" (2022), to early Philadelphia’s history of public health as depicted by David Finger’s "Contagious City" (2013) or to fateful transatlantic voyages of the time as written about by Billy G. Smith in "Ship of Death" (2012).2

Responses to epidemics are a never-ending endeavor as is learning about them. David Barnes’ "Lazaretto" illustrates an early “Age of Uncertainty”3 brimmed with anxiety and unpredictability that can be useful to navigate through our own times of insecurity. The challenge of human decision making in midst of uncertainty is an ongoing collective task that can only be accomplished through “social efficacy” (p. 69, p. 241, p. 248) as Barnes advocates. Through his exceptional scholarship and writing-style, David Barnes turned the history of a forgotten massive, late Georgian style manor into a living monument by bringing “the stories in those bricks” (p. 231) back to life.

Notes:
1 Joan C. Tronto, Caring Democracy. Markets, Equality, and Justice, New York 2013; Deva Woodly, Reckoning: Black Lives Matter and the Democratic Necessity of Social Movements, Oxford 2021.
2 J. Gordon Frierson, Guarding the Golden Gate. A History of the U.S. Quarantine Station in San Francisco Bay, Reno 2022; Simon Finger, The Contagious City, The Politics of Public Health in Early Philadelphia, Ithaca 2012; Billy G. Smith, Ship of Death. A Voyage that Changed the Atlantic World, New Haven 2013.
3 John Kenneth Galbraith, The Age of Uncertainty, Boston 1977.