The Manchester Board of Health was created by a small group of reformers in 1796. Almost immediately, the Board launched a plan to open an institution for the isolation and treatment of poor fever patients, euphemistically called the “House of Recovery.” This proposal for the first stand-alone fever hospital in England set off a storm of controversy in a city already divided along political and religious lines.

The House of Recovery was designed to quarantine patients suffering from typhus, which had only recently been identified as a separate disease entity. The word was first used in this context by François Boissier de Sauvages in 1759. In 1772, William Cullen collected many older accounts of fevers under this name. It proliferated among poor workers crowding into the new industrial towns.

Both sides in Manchester agreed that typhus was contagious but differed on the nature and behavior of contagion. The neighbors of the proposed site and their allies claimed that grouping patients together generated more severe epidemics by concentrating the poison of contagion. They feared the disease would spread to nearby homes, placing them at risk and reducing their property values. Contagious emanations might leap walls, seep out of windows, waft from clothing or even ooze out of the cracks in the sedan chairs used to carry patients. The Board argued that the behavior of contagious diseases was well established and that their precautions would ensure that diseases could not possibly escape. The hospital would enhance the health of the city without endangering its neighbors who were governed by “obsolete prejudices, and by opinions that science now disclaims”.

Both sides tried to deploy knowledge about contagion to win the debate. They ransacked old medical treatises, argued over every detail in every report and procured opinions from respected doctors throughout Britain. Strategies included mass meetings, leaflets, letters to the newspapers and threats of lawsuits. The debate forced participants to address details that they would otherwise have skimmed over and to take more absolutist positions. When the Board opened the hospital, the need to retain support forced them to stick to their arguments despite conflicting evidence. Thus contagionism created its own institutions and those institutions in turn perpetuated contagionism.