The legal history of epidemics in America

Sarah Barringer Gordon, the Arlin M. Adams Professor of Constitutional Law and Professor of History, offers a commentary on American political responses to epidemics past.

Parade from 1918 in the streets with people carrying a large American flag
Image: Courtesy of the Library Company of Philadelphia

In 1918, Philadelphia held a celebratory Liberty Loan parade to promote American citizens’ support for the war. The United States had long delayed entering the Great War raging in Europe. Once in, President Woodrow Wilson presided over an enormous propaganda effort, which included the parade and “liberty loans” (the name given to war bonds). The spectacle was attended by huge crowds, and war bond salesmen were busy on the sidelines.

But there was a problem. Wilson, as well as British and French leaders, all worked with a compliant press corps to suppress reports of a spreading “Spanish” flu for many months. In truth, the pandemic was both widespread and deadly—the deadliest in human history, as far as we know. At least 30 million died (50 million is another common figure; one recent estimate said up to 100 million).

Reactions across America to rumored high death tolls were varied—a reflection of the extraordinary diffusion of power in the United States, especially in matters involving public health. As legal historian Polly Price put it, a national strategy may well be elusive: at the least, it would be “complicated if not impossible.”

In 1918, Philadelphia’s parade was disastrous. Within three days, every hospital bed in the city was full, within six weeks, the death toll was 12,000.  Other cities’ caution proved much savvier. St. Louis was a model—it closed schools, parks, libraries, churches, courts, and more, and had the lowest death toll of any major city.

Such divergent responses are made possible by the long-lived rigor of the “police power” that is vested in states. American federalism, the divided sovereignty that splits national and local government responsibilities, means that more than 2,600 local boards of health are the front line. The national government has power at the borders, but once inside the country, that power evaporates. Even when President Trump ordered cruise ship passengers and evacuees from China to be quarantined, local administrators actually administered and managed that process.

The police power has proven among the most powerful tools of government, especially during epidemics. As Michael Willrich put it in his aptly titled book “Pox,” “Epidemic disease, like war, is the health of the state.” Defined as the authority to ensure the health, welfare and safety of a state population, the police power has sustained drastic responses to epidemics—so drastic, that key questions of individual liberty and bodily integrity have been trampled.

Read more at Penn Arts & Sciences.

Read a Q&A with Sarah Barringer Gordon on the legal history of epidemics in the United States at Penn Law.