‘Easier prevented in the beginnings’
Paul Slack
Quarantine has always been a political tool, imposed on citizens by governments. In 1631, Charles I received a report from one of his physicians, Théodore de Mayerne. The king had asked Mayerne to look into how England’s quarantine procedures, especially in London, could be updated to meet current standards in the more civilised cities of France and Italy. Mayerne pulled no punches. People infected with plague in London should no longer be isolated either with their families at home or in makeshift sheds elsewhere. There should be new hospitals for the sick and separate ones for their contacts. Above all, Mayerne called for the creation of a metropolitan board of health, properly funded and with ‘absolute power’ in time of infection. Only that could guarantee ‘order’, the ‘soul and life of all things’, and so safeguard ‘the public health of all’.
Nothing of the kind was ever attempted in London, and Charles I soon had other problems. In the same year, however, during an outbreak in York, the king’s president of the Council in the North, Thomas Wentworth, assumed authority over the city and its surrounding villages as if he were a one-man board of health. He had heard reports that infected people were ‘very unruly’ and had to be forced ‘to submit themselves to the will of God’ and undergo isolation in their houses. Once he was in command, he reported that the citizens welcomed his presence and were ‘much more orderly than they would be under the government of the mayor alone’. Quarantine was rigidly enforced, and unusual care taken to trace the contacts of those infected and isolate them in pesthouses outside the walls.
The results are striking. There appear to have been scarcely any deaths from plague within the city walls, and only a few in one of the parishes just outside. By contrast, when plague had last visited York, in 1604, 3500 people, nearly a third of the population, had died. The difference could be explained in numerous ways: by changes in the behaviour of rats (the carriers of the disease), or in the virulence of the plague bacillus itself. But it seems difficult to deny that quarantine, ruthlessly applied, had had some effect.
That, however, was very small beer. The real test of quarantine came in the great cities of Italy where it had been invented and become most elaborate. One of them was Florence, where there was also plague in 1631, at the end of a series of major epidemics that had hit northern Italy hard since 1629. There, in a city of 75,000 people, the authorities undertook a vast enterprise of tracking, tracing and isolating the sick and their contacts in lazzaretti. At one point, as Erin Maglaque recently described in the LRB, there was a general quarantine of the whole city, a complete ‘lockdown’ with no one allowed outside. We do not know for certain whether mortality from plague would have been worse without all that effort, but we do know that the death rate – around 12 per cent of the population – was much lower than in other towns and cities in the same epidemic wave.
Quarantine could not have had the impact it did, in Florence or elsewhere, if it had not had public support. Rulers publicised what they took to be their successes in order to reassure the public and outdo their neighbours. There was a jostling for advantage similar to that displayed in political reactions to Covid-19, with each country carefully measuring its comparative performance. In 1656, for example, there was a famous contrast between Rome, where plague victims were successfully isolated in Trastevere, across the river from most of the city, and Naples, which was totally overwhelmed with infection at the same time.
Yet it was never guaranteed that heavy investments in quarantine would reduce mortality in an infected town. They may have done if infected people were successfully separated from their contacts, as many were in Florence. More often, shutting down a whole town or part of it, as in Rome, prevented infection spreading outside, and some of those quarantined were sacrificed for the safety of people elsewhere. The jury is still out on the much larger question of whether a whole armoury of quarantine protections, at crossroads and borders, and in ports as well as major cities, contributed substantially to the disappearance of plague from most of Western Europe by 1750. There seems to me good reason to think it probably did, but that would have been little consolation to those who had paid the price of quarantine over previous centuries.
Part of that price was the long-term damage inflicted when economies were effectively shut down for months at a time. After the 1631 plague in Florence, the grand duke of Tuscany advanced interest-free loans to linen producers in order to support their workers and keep the industry going. Like modern politicians, he must have reflected that the economic costs would have been even greater if plague had not been controlled. Pandemic politics, as we are discovering again, involve trade-offs, public as well as private, and hard choices with no clear winners.
For observers of the present pandemic, however, perhaps the most telling remark from 1631 is Thomas Wentworth’s assertion in York that a plague was much ‘easier prevented in the beginnings than hereafter’. Like a fire, when it got going there was no telling how it would end. Modern epidemiologists would agree, but point out that early prevention is more easily said than done, especially in the case of a viral infection such as Covid-19 which spreads much more quickly than bubonic plague. If the effort to catch and isolate the first cases in an outbreak fails, nothing is predictable. As Defoe said of another plague year, 1665, once an epidemic was fully underway there was no simple remedy, and all the inequities and injustices of quarantine had to be tolerated because they were for ‘the general good’.
Comments
https://medium.com/@notthenewnormal/covid-19-a-risk-assessment-b71f3315c947
There is urgent need for a critique from the left of the ongoing removal of our rights and freedoms being conducted in the name of our safety, which the current Labour Party shows no sign of offering. It would be nice if the LRB could at least give a voice to these concerns.
A very penetrating critique.
It is peculiar that, given that aged, ill & retired people were (and are) the most vulnerable the solution was to prevent the young, fit & employed from going about their business.
The age profile of deaths from the virus are instructive: fewer than 6,000 under 65; fewer than 1,000 under 45.
Deaths of under 15s?
Six