Beating the Dead Horse of Contagionism: Enlightened Democracy vs. Medical “Superstition” in the Early American Republic

David Barnes

David Barnes is Associate Professor of History and Sociology of Science at University of Pennsylvania.

Charles Caldwell, An Anniversary Oration on the Subject of Quarantines (Philadelphia: Fry & Kammerer, 1807).

Francis A. Countway Library of Medicine, R15 .M38 1806 c.3

Charles Caldwell’s Oration is a classic early-19th-century articulation of anticontagionism.[1] To enlightened physicians in the United States, at a time when yellow fever had devastated Atlantic seaports repeatedly for more than a decade, the widespread recourse to maritime quarantine as a defense against the deadly disease represented all of the Old World values against which the fledgling American democratic republic had defined itself. The doctrine of contagion was superstition and autocracy in medical form. American democracy in the Jeffersonian mode demanded an anticontagionist medicine of freedom.

Caldwell, born in North Carolina in 1772, studied medicine in Philadelphia under Benjamin Rush at the University of Pennsylvania. As a student, he treated patients at the hastily improvised Bush Hill hospital during the catastrophic yellow fever epidemic of 1793. Upon graduation, he remained in Philadelphia and established a reputation as a faithful Rush disciple and ardent soldier among the anticontagionist medical corps as the city struggled to come to grips with its economic and demographic growth and with the recurring threat of epidemics.[2]

In 1794, still in shock after the previous year’s deadly outbreak, Philadelphia established a permanent, year-round Board of Health, one of the first in the nation. Its chief responsibilities included overseeing the city’s maritime quarantine and enforcing the cleanliness of public spaces. Quarantine entailed the mandatory inspection of all vessels destined for the Port of Philadelphia, and the temporary detention of the vessels, cargo, and/or passengers who were found to be possible carriers of disease to the city. For most of its first decade of existence, the board was riven by a conflict between the contagionists (who advocated a strict quarantine) and the anticontagionists (who preached public cleanliness). Caldwell was appointed to the board in 1803, and immediately made his presence felt. He steadfastly opposed lengthy quarantines, and for the most part voted accordingly during his year on the board. However, he also recognized that the yellow fever rift had nearly paralyzed the board and rendered it ineffectual. His proposed solution? The board should act in all matters as if both sides were right. If each faction was convinced that its opponents would support both quarantine and urban cleansing, it could be persuaded to do the same. Caldwell pitched the idea to Board of Health President William T. Donaldson, who was generally favorable to quarantine, and Donaldson secured the whole board’s approval.[3]

To call Caldwell an unlikely diplomat understates the case. Incurably thin-skinned, he had an ego to match his imposing height and monumental brow ridge. He never missed a chance to pick a fight or take offense. Casting aside years of Rush’s generosity and favor, he broke with his mentor over a perceived lack of support when Caldwell was lobbying for a professorship at the University of Pennsylvania. He found fault with his professors and with most of the professional colleagues he encountered, pouncing on even the most minor disagreements as opportunities to proclaim his own superior ability, education, refinement, judgment, and courage. His vanity knew no bounds. He proudly claimed to have introduced the “science” of phrenology to the United States, and told his students: “Gentlemen, there are but three great heads in the United States: one is Henry Clay, another is Daniel Webster, and modesty forbids me from telling you who the third is.” (He also took credit for being the first to spread the gospel of mesmerism in the Mississippi Valley.) Such was the man who in 1803 broke the logjam in Philadelphia’s Board of Health by proposing what he called “an amicable compromise.” The determined enforcement of both quarantine and cleanliness served as the guiding principle of the Board of Health for most of the nineteenth century. At the Lazaretto quarantine station on the Delaware River, thirteen miles downstream from Philadelphia, the board developed a quarantine strategy that emphasized disinfection of vessels and cargo and excluded or delayed certain kinds of goods deemed “liable to infection,” while detaining vessels and passengers for relatively short periods of time.[4]

Four years after the “amicable compromise” became a reality, Caldwell delivered the oration to commemorate the anniversary of the Philadelphia Medical Society. He chose as his theme the topic that he returned to time and time again and that defined his career more than any other: the denunciation of quarantine, Caldwell’s perennial bête noire. He called it “erroneous,” “destructive,” and a “false idol” “founded on … superstition and prejudice,” not to mention “bigotry and delusion,” and urged that it be “entirely abolished.” The root of the problem could be traced to the origins of quarantine in Venice and other Italian states during the plague years:

The fifteenth century, which gave birth to these institutions, was a period of physical darkness throughout the world. This was peculiarly the case in Italy, and in the south of Europe in general, where the human mind was led most astray by the delusive wiles of priest-craft, and groaned under the heaviest load of papal tyranny.

The speech contrasted “the dark ages, when Europe was a stranger to physical science,” to “the advancement of science in modern times,” when the “superstitious” atavism of quarantine “remained immersed in its primitive darkness.”[5]

Amid all of this vitriolic rhetoric, and shortly after calling for quarantine to be “entirely abolished,” Caldwell concluded his oration by recommending something quite different:

[S]hall there, then, be no quarantine establishments in the United States? and shall all vessels from tropical climates, whether healthy or not, be suffered at all seasons of the year to enter our ports immediately upon arrival?

His answer was no. Instead of shutting down the Lazaretto and other quarantine stations, he called for them to shift away from lengthy detentions of forty days (the etymological origin of the word “quarantine”) to thorough “purification” (disinfection) of vessels and cargo over the course of just a few days.[6] Caldwell surely knew full well from his time on the Board of Health that forty-day quarantines were so rare as to be virtually nonexistent. And he certainly had the means to ascertain that standard practice of quarantine at the Lazaretto resembled quite closely what he was calling for in the speech in 1807: short detentions for the purpose of disinfecting vessels and cargo were far more common than lengthy detentions of vessels and passengers.

Why, then, the overheated rhetoric and call for abolition? The answer lies not in the reality of quarantine in 1807, but in the ideological symbolism of “quarantine” and “contagion” in the Age of Enlightenment. “Superstitious” was one of the insults most commonly directed at contagionism and quarantine; critics loved to point out that they originated during the “Dark Ages” when European cities were desperate to keep the plague away. Anything associated with the age of irrational credulity and ignorance was marked with a disqualifying taint. In the early nineteenth century, in the New World that boasted of freedom and equality, the Old Regime of kings and aristocrats and superstitions belonged to the distant past. Contagion and quarantine stank of ignorance and the unthinking acceptance of tradition. They were an intolerable affront to the Enlightenment spirit of rationality and progress that animated the likes of Benjamin Rush, Charles Caldwell, and their like-minded colleagues. Proclaiming antipathy toward them became a virtue-signaling habit, one that persisted well after the last true contagionists in medical circles had fallen silent or died.

Anticontagionism suffers the misfortune of being named after what it opposed rather than what it supported: freer trade and cleaner and better-ventilated cities, among other things. Its positive commitments made a real difference in nineteenth-century environments. However, as an intellectual movement, 19th-century anticontagionism defined itself—self-consciously, habitually, even at times obsessively—in opposition to a bogeyman that was (depending on the country) either dead or dying: doctrinaire, autocratic quarantine based on anti-intellectual, quasi-medieval contagionism. When Caldwell gave his oration in 1807, contagionism in medical circles was powerless, irrelevant, and well on its way to oblivion. Caldwell meant his Oration as a rallying cry for the anticontagionist troops within Philadelphia’s medical community. Had he and his audience cast their eyes thirteen miles downriver to the Lazaretto, they would have realized that their battle had already been won.



[1] On the history and historiography of anticontagionism, see Erwin H. Ackerknecht, “Anticontagionism Between 1821 and 1867,” Bulletin of the History of Medicine 22 (1948): 562–93; Roger Cooter, “Anticontagionism and History’s Medical Record,” in Peter Wright and Andrew Treacher, eds., The Problem of Medical Knowledge: Examining the Social Construction of Medicine (Edinburgh: Edinburgh University Press, 1982), 87–108; and Christopher Hamlin, “Ackerknecht and ‘Anticontagionism’: A Tale of Two Dichotomies,” International Journal of Epidemiology 38 (2009): 22–27.

[2] On Caldwell’s life and career, see Charles Caldwell, Autobiography of Charles Caldwell (Philadelphia: Lippincott, Grambo, and Co., 1855); William Shainline Middleton, “Charles Caldwell: A Biographical Sketch,” Annals of Medical History 3 (1921): 156­­–78; and Thomas L. Maddin, “Remarks of Dr. Maddin,” The Southern Practitioner 25 (1903): 263.

[3] Caldwell, Thoughts on the Subject of a Health Establishment for the City of Philadelphia (Philadelphia: n.p., [1802]), 11–13; Minutes of the Philadelphia Board of Health [April 25, 1803], Philadelphia City Archives, RG 36; Gazette of the United States, May 6, 1803.

[4] Caldwell, Autobiography, 288–92; Middleton, “Charles Caldwell,” 156–78; Maddin, “Remarks of Dr. Maddin,” 263; David S. Barnes, “Cargo, ‘Infection,’ and the Logic of Quarantine in the Nineteenth Century,” Bulletin of the History of Medicine 88 (2014): 75–101.

[5]Charles Caldwell, An Anniversary Oration on the Subject of Quarantines (Philadelphia: Fry & Kammerer, 1807), 4–6, 8–9, 13, 21, 26.

[6] Caldwell, Oration, 26.