HEALTH

Contagious Disease Control

The Lazaretto

City efforts to control contagious disease began in the late 18th century with the establishments of the quarantine hospital for the Port of Philadelphia called the Lazaretto. The Lazaretto was built in 1799 a few miles below the city on Little Tinicum Island on the Delaware River. At the Lazaretto, the passengers, crew and cargo of all vessels arriving from foreign and domestic ports were subject to rigid examination. The sick were removed to the Lazaretto hospital and all cargo liable to contain infection was removed for storage in the public warehouse. The Board of Health enforced the quarantine regulations for the Port of Philadelphia at the Lazaretto until authority was placed under State regulation in 1893.

The beginning of yellow fever in Philadelphia in 1870 was traced to the brig Home that arrived at the Lazaretto from Jamaica on June 29, 1870. At the time of the vessel's arrival it was suspected that the captain, who had died during the passage, was a victim of yellow fever. As a result, the vessel was detained and anchored in the inner channel by the Lazaretto. The vessel's pilot obtained permission to proceed to the Capes of the Delaware but went on to Philadelphia instead. Within days crewmembers were taken ill in the city with yellow fever. Throughout that summer, numerous Philadelphians were stricken by the disease.

The Municipal Hospital for Contagious Diseases

The Municipal Hospital for Contagious Diseases was built in 1810 on Bush Hill in the Fairmount area near the site of the 1793 yellow fever epidemic hospital. There it remained until it was closed in 1855. It reopened 10 years later at 22nd Street and Lehigh Avenue and at that time treated only smallpox patients. Patients suffering from other diseases such as diphtheria, typhoid fever, measles, and scarlet fever were treated at the general hospitals of the city. By the late 19th century, those hospitals began to refuse treatment to such victims; and the Municipal Hospital became the only place in the city for their reception.

As a result of the increased demands on the Municipal Hospital facility, numerous new treatment pavilions and upgraded facilities were constructed on the site during the 1890s. In 1902, the decision was made to move the hospital to a less populated area of the city to reduce the danger of contagion. The city purchased a new site at Front and Luzerne Streets for the construction of an entirely new Municipal Hospital complex that officially opened in 1909.



Bureau of Health ambulance, 1902.



The new Municipal Hospital for Contagious Diseases under construction at Front and Luzerne Streets, 1909.

Convalescent children taking a sun bath at the Municipal Hospital, May 1912.

Typhoid fever death chart, 1886-1926.

This graph illustrates the reduction in the death rate from typhoid fever in Philadelphia, as pure filtered water supplies became available to all city residents. The danger of typhoid fever as an epidemic was eliminated with the completion of the city's water filtration system in 1912.

The causes of many infectious diseases were not known during the 19th century. The Bureau of Health charted the annual courses of various diseases such as smallpox, typhoid fever, and diphtheria in an attempt to discover correlations between the outbreaks of disease and meteorological observations. Recording the incidences of various diseases was necessary to enable the successful development of effective public health programs. In 1904, reporting of communicable diseases by private doctors became a legal requirement.

Graph illustrating the rising rate of cancer deaths from 1880-1924.

The death rate for many diseases began to decline in the early 1900s as a result of quarantine measures, the availability of pure municipal water supplies and improved sanitation. Throughout the 20th century, the leading causes of death have shifted from infectious diseases such as pneumonia and tuberculosis to chronic diseases such as stroke and cancer.

Vaccination

The smallpox vaccine was officially introduced in Philadelphia in 1801 but few individuals chose to be vaccinated. In an effort to increase vaccinations, a city ordinance in 1860 turned over to the Board of Health the authority to direct the public vaccination campaign against smallpox. An important feature of the new ordinance was the appointment of city vaccine physicians and vaccine case collectors. The City was divided into districts and a physician assigned to each. It was his duty, either in person or by means of a collector, to visit every house in his district and offer his services and urge the importance of vaccination. But the public campaign was voluntary and many people still refused vaccination. Vaccinations increased only in epidemic years. During the 1871-72 smallpox epidemic, 4,000 Philadelphians died and 30,000 persons were vaccinated. There were no deaths from smallpox in 1878 and only 9,000 received the vaccine. The Board of Health continued to call for a compulsory law requiring every child born or brought into the city to be vaccinated. However, it was not until 1895 that the State of Pennsylvania's General Assembly finally passed a law making smallpox immunization compulsory for school attendance

Representatives of the Board of Health canvassed their appointed districts to enlist citizens to be vaccinated. Most reported that, despite every persuasive means used to encourage vaccination, people remained skeptical and refused to have the procedure performed.

In 1894, the Division of Pathology, Bacteriology and Disinfection was created. Its duties included diagnostic testing in all cases of diphtheria and tuberculosis. The Public Health Laboratory was opened in City Hall in 1895. Police stations were designated as the distribution and reception centers for culture tubes. Physicians could obtain culture tubes there and have the tubes sent promptly to the laboratory for examination. Anti-toxin produced by the Division was also was distributed at these stations free of charge to physicians for treatment of patients unable to afford the remedy.