As with most early public health initiatives, the establishment of the Lazaretto responded directly to a local crisis: in 1793, a yellow fever epidemic devastated Philadelphia, claiming one-fifth of its population. All but a handful of determined citizen-caretakers abandoned the city, compounding the ill-effects of the shocking mortality rate. Despite Philadelphia's position as the most cosmopolitan city in America, it still lacked the municipal organization and the facilities needed to contend with a large-scale epidemic.
Built between 1799 and 1801, the Lazaretto Quarantine Station was among the earliest purpose-built, and is the oldest extant, quarantine-related structure in the United States. The building's high level of integrity is of particular importance since it is physical evidence of the forces impacting the eighteenth-century American hospital—both in terms of public health policy and in the edifices shaped by that policy.
The City of Philadelphia's Board of Health erected the Lazaretto to protect its citizenry against infectious diseases long before the federal government involved itself with such concerns. Nearly a century passed before the opening of the first permanent quarantine and immigration station on Ellis Island in New York Harbor.
While the Lazaretto Quarantine Station and other similar, early-19th-century centers are precursors to this later, far-better-known facility, each had a well-defined purpose relative to its time and place. Activities at the Lazaretto made little distinction between the people or cargo carried on ships as sources for epidemic disease. Each was inspected and detained based on the presence of a perceived health threat and only released when that threat had passed over time or through purification.
It was home to the Pennsylvania Hospital, the only institution of its kind in America at that time; however, because it was conceived to cure, rather than merely contain, the sick, the hospital literally shut its doors during the 1793 epidemic, as did the nearby Alms House, the conventional repository for the sickly poor. The abject failure of the city to deal with this catastrophe hastened the creation of the Philadelphia Board of Health in 1794, the first permanent municipal health organization in America. The rationale behind its establishment not only concerned the practical maintenance of public health, but perhaps more importantly, future avoidance of civic paralysis in times of crisis and the restoration of the public trust in all levels of government.
Lacking even basic medical knowledge required to prescribe effective treatments for disease, contemporary public-health policy primarily sought to quarantine the sick from the healthy. The series of legislative acts that created, structured, and refined the responsibilities of the Board of Health eventually resulted in the construction of two hospital complexes with similar, seasonal functions—a "City Hospital" located at the edge of the urban center and intended to separate sick residents of Philadelphia from the healthy during epidemics, and a quarantine station, called the Lazaretto, meant to contain people with infectious diseases approaching the city by ship at a location remote from the metropolis. It can be suggested that the Board of Health realized the new quarantine station's centerpiece building on formal plans by English architect-émigré Joseph Bowes, but eighteenth-century vernacular traditions most impacted its massing and spatial organization. The main building's visually dominant center pavilion and simpler flanking hyphens emerged from a generic English formula that colonists imported and adapted to meet local requirements and conditions. This process previously gave shape to Philadelphia's Pennsylvania Hospital, which became an influential forerunner for many eighteenth-century American structures related to social welfare.
The Pennsylvania Hospital single-handedly launched a new domestic vernacular form that allowed for economical construction within the limitations of Philadelphia craftsmen who spent much of their working life building houses. Rather than convey its public presence through innovative materials and construction techniques, the Lazaretto's main building attained the desired presence and scale by linking three separate, domestic-type structures into a single unit. Although physically and functionally separated by unbroken party walls, the three parts were visually unified and aggrandized by an exterior piazza running across the building's riverfront.
The octagonal cupola and vane perched on the center pavilion's roof relieved any remaining doubt of the building's public nature. The main building at the Lazaretto was among the last of its kind and is now a rare, quite probably unique, survivor. Built concurrently with the Lazaretto, Benjamin Henry Latrobe's innovative and influential Bank of Pennsylvania set new standards and represented the future of American public-building design. Despite later use as a gentlemen's athletic club and an early base for seaplanes in the United States, the structure is likely the least adulterated example of an eighteenth-century hospital remaining in the country.