The elegant Georgian structure, built when John Adams was America’s president and Philadelphia its capital, still sits on a picturesque Delaware River landing, a brick-and-columned reminder that this region experienced infectious diseases long before COVID-19 arrived.

That 221-year-old building in Essington, just south of Philadelphia International Airport, was the centerpiece of the Lazaretto, a 10-acre facility where throughout the 19th century, the city quarantined disease-infected immigrants and crew members bound for its bustling port.

And while it’s been more than a century since patients were isolated and treated there, the history of the Lazaretto – Italian for “lepers house” – might provide lessons in 2020 for those coping with a coronavirus outbreak that has closed much of America.

In use from 1802 until 1895, an era when deadly epidemics were commonplace and hygiene and sanitation haphazard at best, the Lazaretto was an unusually effective health institution.

“We’ve got detailed records from 1847 on and they show that 78% of yellow fever patients treated there and 95% of those with typhus were cured,” said David Barnes, a Penn professor who specializes in public health. “Overall, I think 88% of patients treated there survived. That’s not a bad batting average for the 19th century, especially when they were dealing with such deadly diseases.”

Recently, after decades of neglect, the Lazaretto’s main building, which includes two hospital wings, was repurposed to serve as Tinicum Township’s administrative offices. Officials moved into the Western Hemisphere’s oldest surviving quarantine hospital just days before the coronavirus outbreak hit.

“It’s all just soaked in irony,” said Barnes, who is writing a book on the Lazaretto. “The restoration took much longer than anticipated. The township finally moved in and a week or two later the pandemic shut everything down.”

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In the 1800s, long before social distancing, the Delaware River in Philadelphia was clogged with sloops, barges, and packet ships hauling cargo and immigrants here.

Four deadly yellow fever outbreaks had hit the city in the 1790s, including one in 1793 that killed 10% of the population. According to Barnes, the neighborhoods most affected were those abutting the docks with their towering skyline of wooden masts.

“There were piers roughly from a little north of Vine Street down to Catharine Street,” said Barnes. “That area back to Second Street is where the yellow fever was concentrated.”

The city’s medical community was divided on how contagious diseases like yellow fever and typhus arrived here and spread. Some felt they originated in filth and when temperatures rose formed a deadly miasma. Others disagreed, believing it was carried here by ships and spread person to person.

“After battling it out for years, they reached an uneasy truce,” Barnes said. “Both sides got what they wanted. The Board of Health said we’re going to clean up the city as best we can, and we’re going to quarantine.”

Researchers finally discovered in 1900 that yellow fever is a virus transmitted when an infected mosquito bites a person. It had been brought to the United States on those ships from the West Indies. Though there is no direct medicine for yellow fever, most people recover on their own.

Typhus, on the other hand, is a bacterial disease transmitted person to person by lice. It can be cured with antibiotics and is now rare.

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Quarantining had been employed against contagious diseases since Europe’s Black Plague in the 14th century. By the 1820s, most American ports had quarantine hospitals or “pest houses.” The first here was at Fort Mifflin, the second in Marcus Hook.

But the relentless diseases soon overwhelmed them and in 1799 work began on a new and larger facility on an Essington riverbank, a point passed by all Philadelphia-bound ships.

In the warmer months, when diseases prowled the crowded piers, city law required all river traffic, even ships headed north to Trenton and elsewhere, to be diverted to the Lazaretto.

“The Lazaretto’s physician and quarantine master would board and inspect the cargo to see if there was contamination,” said Barnes. “Then the physician would interview the captain and inspect passengers and crew for signs of illness. He’d then make a decision about whether to detain the ship, the cargo, or passengers or to allow it to proceed.”

Barnes estimated tens of thousands of patients were treated there. According to an 1847 newspaper account, between June and October that year, 529 ships were inspected at the Lazaretto, 262 from overseas. A total of 7,808 immigrants were examined. Of those, 300 were admitted and 35 died.

Most Philadelphia-bound immigrants came from Europe, at first England, Ireland, and Germany, later southern and eastern nations. The bulk of the cargo, meanwhile, was from the West Indies.

All those vessels accessed the river from the Delaware Bay. Captains hoping to circumvent the inspection process often unloaded south of the city, in New Castle or Wilmington.

Lazaretto patients occupied the hospital wings, or the barracks and cabins that along with a morgue, disinfectant house, and pier were located on the site. Often its proximity to population centers like Chester caused public concerns.

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That was especially true in 1870 after the captain and passengers on a yellow fever-infected ship from Jamaica died and the Lazaretto’s physician, quarantine master, and a nurse contracted the illness.

Barnes estimated the facility, operated by Philadelphia’s Board of Health, had a staff of 15 to 20, “including a couple of domestic servants for the physician and quarantine master.”

“My argument is that supportive care is what made a difference,” Barnes said. “Food, drink, clean clothing, clean bedding, rest, and nursing care. As for medicine, most of the medical textbooks were prescribing aggressive depletion like bloodletting and purging. But they also got a treatment of gentle tonics, which included quinine and wine or brandy to stimulate the body. Sometimes there was morphine for pain relief or to help them sleep.”

For most of the Lazaretto’s operational life, Barnes noted, health inspection was the only formal immigration process that existed. Those who passed those examinations continued on to one of the Delaware River piers and disembarked.

That changed in the 1890s when the federal government assumed control of immigration. It set up a disinfectant station on Reedy Island on the Delaware River and an immigration station at the foot of Washington Avenue where newcomers were registered and inspected.

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The Lazaretto closed in 1895. It later served as a post office, a retirement home, a private club, and a flight school. Philadelphia aviator Frank Mills bought it in 1937 for $10,500, and it stayed in his family for decades.

Eventually, the three-story structure was abandoned and forgotten. Passengers on planes landing at Philadelphia International Airport often remarked about the old building they spotted from their windows. Finally in 2005, after plans for a bed-and-breakfast collapsed and historians voiced concerns about its fate, the township bought the property.

“That was crucial,” said Barnes, “Tinicum had grant money to build a new township building and it was able to use it to buy and restore the Lazaretto.”

A Penn colleague told Barnes about the Lazaretto in 2006. At work then on a history of public health in 19th-century France, the professor quickly diverted his focus and for the last 14 years, he said, “it’s been an obsession.”

He’s now developing an audio tour and working with a group that’s created a vision plan for the refurbished facility. They hope to stage events there and make it a tourist destination.

“It’s pretty spectacular now,” Barnes said. “I think it was beautiful before but in a decaying way. Now it’s shiny and gorgeous.”