Cities and Epidemics in History

Dense urban populations have fostered and accelerated epidemics since at least the Plague of Athens in the fifth century BCE, and epidemics have in turn reshaped urban spaces for almost as long. When bubonic plague swept from Central Asia across Europe in the fourteenth century CE, Mediterranean city-states began to establish Lazarettoes (quarantine stations and hospitals) near the entrance to major seaports, often on islands. Ships, passengers, and cargo arriving from ports where disease was suspected could be temporarily detained there in order to prevent the introduction of an epidemic into the city. Lazarettoes were an early example of the state asserting its power by exercising control over urban space. (Philadelphia’s Lazaretto on the Delaware River in Tinicum Township dates to 1799, in the aftermath of four deadly yellow fever epidemics.)

Cholera spread across Europe and North America several times in the nineteenth century. In 1854, London doctor John Snow attempted to prove his theory that the disease was spread through contaminated water by mapping every case in the Golden Square neighborhood, then asking each household where it obtained its drinking water. Snow identified the culprit as a pump on Broad Street, which he had shut down (after the epidemic was already on the wane). When an oppressively foul odor settled over large areas of London four years later, fear of another epidemic galvanized political momentum in favor of a massive new sewer main (contained by the new Thames Embankment) to safely evacuate the city’s waste. The horror of cholera also provoked Edwin Chadwick’s pioneering British sanitary report of 1842 (which led in turn to the Public Health Act of 1848) and helped inspire Baron Haussmann’s rebuilding of central Paris in the 1850s and 1860s. Haussmann gave the city huge new parks (“the lungs of the city,” in Olmsted’s memorable phrase) as well as water mains and sewers; municipal governments throughout rapidly urbanizing Europe and North America soon followed their example.

Anti-Chinese racism is nothing new in American responses to epidemics. San Francisco’s Chinatown was cordoned off from the rest of the city in 1900 when bubonic plague broke out. Armed guards prevented anyone from entering or leaving, and some white nativists advocated simply burning it down. Cities condense into its purest form the fear of filth, of bodies, of strangers, and of the Other.

Sometimes, cities under-react. In the midst of the influenza pandemic in 1918, Philadelphia allowed a huge fundraising parade for wartime bonds to go ahead as scheduled. Two hundred thousand thronged Broad Street, and within three days, every hospital in the city was filled with flu patients. Thanks to its insouciance, Philadelphia paid a higher toll to the pandemic than most other cities.

More recently, the 2003 SARS epidemic focused fears of cities and contagion on Hong Kong, with its densely crowded population. News media at the time sensationalized the story of the Chinese doctor who visited the city for his nephew’s wedding and unwittingly infected seven other guests staying on the ninth floor of the Metropole Hotel. Those guests traveled back to their home countries and spread the disease further. Ultimately, the World Health Organization (WHO) traced about 4,000 cases of SARS worldwide to that one hotel guest in Hong Kong.

The equivalent of the Metropole Hotel for the COVID-19 pandemic is the Huanan Seafood Wholesale Market in the Chinese city of Wuhan. Whether or not the disease actually originated there, the market represents many of the things that people fear about cities: disorder, the crowding together of large numbers of bodies, and uncontrolled contact with strangers of unknown origin and habits. Add to that the close proximity of live and dead specimens of many exotic animal species, and you have plenty of fodder for bourgeois Westerners’ nightmares.

After COVID-19 has passed into history, economic opportunities, services, amenities, and cultural resources will no doubt continue to exert a centripetal force drawing people to cities. Some will go in spite of their fears. Let us hope that public health officials and city planners continue to mitigate the hazards of urban life while cultivating those features that help cities enhance their residents’ well-being.

David Barnes is Associate Professor, History and Sociology of Science, Penn School of Arts and Sciences, and a Penn IUR Faculty Fellow.

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