Pandemics, quarantines, and history

How did you get interested in this topic? 

I’ve been interested in quarantine for a long time. At the end of college, as I was working on a paper about European travelers in Egypt in the 19th century, I came across a guidebook from the 1840s, the first British guide for travelers to Egypt. Almost the whole introduction was about dealing with quarantine on the return trip. A central rationale for this system was the occasional presence of bubonic plague epidemics in Middle Eastern cities, but even when there were no reports of any disease, every person traveling from the Middle East to Western Europe needed to be quarantined, usually for at least three weeks. I found this amazing, and I still do. The quarantine system ensnared millions of people over its existence, roughly from the mid-eighteenth century to the 1850s. These people had to have their clothes fumigated, had to hand over every piece of mail to be dipped in vinegar and smoked. Sometimes, you can still smell that on early nineteenth-century letters.

It was just really interesting that in this early period, a international medical system existed on this scale. This continental border was so real and tangible and intense at a time when we are not expecting to find such a transnational system.

And this system was built from the ground up by low-level bureaucrats in Mediterranean port cities. Through the regular exchange of letters among local boards of health, mutually assured disinfection emerged. That is, boards of health made it known to other boards: If your procedures aren’t up to snuff, ships from your port will be quarantined elsewhere in Europe. As I’ve researched my book, it’s been so fascinating to see how this shared, continental transnational border took shape.

For the average person, what are some key takeaways from your book?

One would be the way that elite, national politicians were forced to go along with the procedures that bureaucrats in port cities developed. All these members of the boards of health had developed their rituals and traditions of disinfection, and, sure, there were government ministers who thought quarantine was ridiculous and over the top. More than 90% of ships being quarantined came from cities with no reports of disease and had no disease on board. But because boards of health had built such tight links with each other and could always point to the threat of retaliatory quarantine, politicians who wanted to relax procedures were brought on board.

Another takeaway people might find interesting is how much some of these disinfection procedures and ideas from another era resemble beliefs we continue to hold. This is a period before germ theory, and diseases were understood to be spread in various ways: Advocates of quarantine suggested there was some nebulous contaminating substance called ‘contagion,’ but opponents of this idea stressed causes that were more atmospheric and environmental.

Some of the procedures that happened during nineteenth-century quarantine are still being used today. Alcohol, vinegar, and chlorine were some favorite disinfecting substances both then and now. And even though we think we’ve moved way beyond ideas that some ‘miasma’ in the atmosphere can make you sick, you still see traces of environmentalist medical ideas too. Lots of people say, for example, that swamps are unhealthy—and not just because they breed mosquitoes—that being inside with really intense air conditioning and then going out into hot weather can give you the flu. Or your parents might tell you: ‘Don’t go outside with wet hair, you’ll get sick.’ We still have understandings of disease, contagion, and contamination that go well beyond the science of bacteria and viruses.

And a final major takeaway that really resonates with the present is the dramatically different way people of different classes experienced quarantine in the period I write about. If you were rich, and the people who published travel narratives about quarantine generally were quite wealthy, the whole thing often sounds unexpectedly great. ‘Oh, it might be a little bit sinister, but I managed to catch up in a lot of reading, and the food was wonderful.’

The vast majority of people quarantined, though, were sailors, soldiers, and fishermen who had to move back and forth across the Mediterranean. These people were crammed into tiny rooms, and they had to stay there for weeks. This would have been almost unbearable, and you get glimpses of it even in accounts written by very rich people. One such traveler, for example, who could pay for private lodging at a quarantine station at the Austrian frontier, casually mentioned seeing a crowd of 300 peasants crossing from the Ottoman Empire who couldn’t afford to rent any kind of shelter and had to camp outside in freezing weather for 10 days while wearing clothes that had been ‘fumigated’ by dipping them in cold water.

In his review of your book, David Barnes, associate professor of history and sociology of science at Penn, says the book ‘delves deeply into one of the great questions of the 19th century, and indeed of our own age: What are the responsibilities of the modern state?’ What did you find those responsibilities are?

Quarantine is really the oldest precedent that the government needed to invest itself in the health of the nation as a whole, that putting money from taxation behind a medical measure was legitimate. So, it’s a crucial precedent for our modern understanding that the state should be responsible for public health, for the wellbeing of its citizens. Also: Long before there were passport control lines, quarantine constituted a major border regime. There are many ways this system shaped our understanding of what modern states should do.

What can governments today take from what Britain and its Mediterranean trading partners did?

I think my work shows that quarantine policy worked most effectively when politicians stayed out of the way. For the most part, the boards of health that ran the lazarettos [quarantine stations] had professional integrity that enabled the system to function.

All told, quarantine practices and debates contributed to the idea that medicine formed its own sphere of expertise where professionals should be in charge. That’s certainly a relevant lesson today, especially in the United States. Equally important: Quarantine can easily reinforce racism and stereotypes. When the practice is necessary, we need to think about way it can be applied as universally, equally, and sensitively as possible.

How does your research inform what is happening now?

From reading a huge number of travel narratives about quarantine, I have some pretty good ideas about how people have dealt with long periods of medical isolation. It’s a different kind of routine, a change of pace that take some adjusting to, and especially if we can disengage from the 24/7 news cycle—something I’m finding pretty hard to do in these days of coronavirus—social distancing could be more manageable.”

Benjamin Disraeli, way before he was prime minister of the United Kingdom, traveled to the Eastern Mediterranean in his 20s, and when he came back to Western Europe he was quarantined for several weeks. Despite having complained to his father about how much he was dreading this, Disraeli spent the time finishing writing a novel and later claimed that reading old newspapers that were lying around the Lazaretto of Malta is what made him ‘understand politics.’

So, as we seclude ourselves from normal life more than we ever have before, if we want to learn from the travelers who experienced quarantine two hundred years ago, we should think about how important it is to develop routines and cultivate small pleasures. I’ve been cooking a lot, and it makes me remember one traveler who said that in quarantine, eating dinner was the ‘great event of the day.’ In many of the travel narratives I’ve read, quarantine was something people didn’t hate as much as they thought they would, which is something optimistic we can take from that time.