Contagion: How Commerce Has Spread Disease 
by Mark Harrison.
Yale, 376 pp., £25, August 2012, 978 0 300 12357 9
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The Eclair was a British steam sloop charged with policing the slave trade. In November 1844 she set out hopefully in a naval squadron for Sierra Leone, where she spent five months patrolling for slavers. West Africa was known to harbour ‘fevers’ to which Europeans had little resistance, but the officers and crew remained in good health, and the sailors were even granted shore leave, which they were described as enjoying immensely. After 13 days, the Eclair proceeded to the Gambia, at which point many of the men were seriously ill and bringing up blackish vomit. By the time the ship made Boa Vista in the Cape Verde Islands, one in six men had died. The survivors were taken ashore: healthy men were put up in tents, healthy officers in a house, and the sick men kept on a nearby island. And people kept dying. Three different naval surgeons advised the captain to flee for Madeira’s cooler and healthier climate. But nearly two-thirds of the crew who left Boa Vista were dead by the time the Eclair reached Funchal, so they sailed on, thanks to volunteers who stood in for the fallen crew, to Portsmouth. When the Eclair finally anchored on 28 September 1845, there had been ninety more cases of fever and 45 more deaths.

The plague aboard the Eclair was identified as yellow fever. It takes its name from the jaundice it causes in its patients as their livers fail; the black vomit is the result of internal bleeding. We now know that it’s communicated by a mosquito-borne virus – however horrifying, it’s at least not contagious. But in the early 19th century it was feared that the fever could be transmitted from person to person, and so the Eclair was placed under quarantine for 21 days, under the 1825 Quarantine Act, a measure which prevented the crew from receiving fresh medical supplies. After the press reported mounting casualties, the men were transferred to better-equipped vessels. Slowly, the mortality rate levelled and then dropped; no new cases emerged and the survivors began to recover. Quarantine was lifted on 31 October and the men were paid off. While mopping up one noxious outcome of European imperialism, the men of the Eclair had suffered from another, the globalisation of disease.

Diseases can travel impressive distances, though almost never without assistance. It’s not entirely clear where the Black Death originated and how it spread, but it’s likely to have begun in China and subsequently moved along caravan routes to the Near East, as an unintended tax on the silks and spices. Merchant ships then transferred the goods and the pestilence to Europe and Africa. Alternative routes and different stopping points have been proposed for the Black Death, but traders always make an appearance: commerce is a constant.

So too is suspicion of commerce. In 1348, as plague spread through the Mediterranean, Europeans stopped buying new spices. These were thought to bring health and a long life, but that year’s supply was assumed to be tainted. Political authorities went further by banning merchants, not just merchandise. The Italian city of Pistoia led the way, with ordinances in 1348 that forbade its citizens to have contact with anyone who carried wool or linen cloth or who had come from any area known to harbour plague. Venice instituted a sanitary council in the same year to regulate ships’ traffic and manage lazarettos for the sick or suspected sick. The Republic of Ragussa (the Italian name for Dubrovnik) stipulated in 1397 that vessels were to be detained for as many as forty days, in order to prevent the landing of disease along with the cargo. That measure became known as quarantine, after Jesus’ forty days in the wilderness.

Fear of foreign merchants existed alongside an increasing dependence on them. It is by now almost standard for academic historians of medicine to argue that things don’t inevitably get better over time, and that medical experts (including doctors) aren’t always agents of progress. In Contagion: How Commerce Has Spread Disease, Mark Harrison confronts two narratives of modern history: the consolidation of professionalised medicine, and the spread of Western economic ideas, including commerce in its capitalist incarnation. He shows that these developments, both moving in the direction some would call progress, quite often collided with each other.

Medieval and Renaissance doctors had shown little interest in the way disease spread, only in how it operated on the body. There was no need to close the ports, they thought. The concept of contagion was only gradually assimilated into medical literature, even though it had long been accepted by ordinary people and public authorities. Muslims in the Near East and North Africa tended not to quarantine. Nor did the Mughals or the Chinese. Harrison argues that differing ideas of political rights and duties may have mattered more than medical traditions. ‘Put simply, more was expected of European rulers,’ who felt obliged to do something when epidemics loomed, rather than simply offer charity once one had started.

By the early 17th century, quarantine was frequent within Europe, along with embargoes on suspect goods. It was also a way to exclude social undesirables. By the time of the Anglo-Dutch wars of the later 17th century, quarantines and sanitary embargoes had begun to serve political purposes: measures to prevent the spread of plague constituted war by other means. High mortality rates (35,000 in Amsterdam alone in 1664) made it clear that the danger wasn’t imaginary, but whether trade stoppages were a good idea, given the economic damage the plague had already caused, was in doubt. And yet the practice of quarantine spread. The first visible cordon sanitaire was created along the border between the Austro-Hungarian and Ottoman Empires. In 1710 a thousand-mile stretch was lined with watchtowers and patrolled by soldiers who were told to shoot on sight anyone who tried to sneak over from Ottoman territory without observing quarantine.

But by the late 18th century, ‘anti-contagionists’ and ‘contagionists’ were sparring over embargoes and quarantine measures. Anti-contagionists tended to be liberals, supporters of the free flow of people and goods, while contagionists preferred vigilance. The difference was especially apparent in debates over an outbreak of yellow fever that hit Philadelphia in 1793: Federalists thought the disease had arrived with refugees from the slave revolt on Haiti; Republicans blamed local conditions. When cholera struck Europe in the 1830s and 1840s, authorities in the port of Hamburg did little to regulate traffic while their less trade-oriented counterparts in Prussia were pro-quarantine. Quarantine measures could be used to control trading partners or punish rivals. Rather than raise tariffs, Egypt’s quarantine measures raised the cost of imports, which had much the same effect; Russia used quarantine to harass merchants and travellers.

Haphazard local regulations worked against the spirit of the Congress of Vienna, which, at the end of the Napoleonic Wars in 1815, had smoothed over many of the causes of the conflict. In 1851, delegates from 12 Mediterranean states, including the Ottoman Empire, met in Paris for the first international convention on quarantines. While there was no binding agreement, the meeting created a model for gatherings of this kind. The next sanitary convention was in Constantinople in 1866; many others followed, with a final prewar meeting in Paris in 1938.

Two things have complicated all modern efforts at sanitary regulation. The first is the accelerating speed at which disease can be transmitted, first on steam-driven vehicles, later on petroleum-fuelled ones, particularly aircraft, with shortcuts such as the Suez and Panama Canals also speeding things up. (On the plus side, medical warnings also circulate very much faster.) The second factor was empire. In the British colonies, beginning in the West Indies, quarantine came to be seen as a ‘vexatious restriction’ which hampered trade and damaged an empire that depended for its efficient working on the free circulation of labour. Other imperial powers enforced their own, conflicting policies. But it was only just before the Second World War that a shift away from quarantine and towards surveillance came to represent a more subtle kind of sanitary regulation.

Since 1995, much of the regulation has fallen to the World Trade Organisation. But individual nations, trading blocs and business groups have been active in protecting their interests against WTO agreements. The result has been a continuing atmosphere of suspicion, as seen, for example, in bans on US beef in 2003, after a case of BSE was identified in the States. The WTO helped to lift the embargoes, but while the Korean government insisted that imported beef was safe, diners thought otherwise. ‘I could study hard in school,’ one schoolgirl complained, ‘I could get a good job and I could eat beef and just die.’ It took ten years for the EU ban on exports of British beef to be lifted after BSE was first found in UK cattle in 1996, and testing continued to be mandatory until last year. Distrust is everywhere: of government officials, scientific experts and international organisations.

The transfer of disease from animal to human is a recurring theme: the Black Death from rodents to humans in the Middle Ages, the many outbreaks of parasitic infection from eating tainted pork, the likely contraction of plague from Siberian marmots in 1910, the variant Creutzfeldt-Jakob Disease that results from BSE, the occurrence of Sars in humans who were in contact with mammals in China, as well as epidemic influenza (including H5N1 and H1N1) contracted from poultry and swine. The Sars outbreak alone is estimated to have cost $50-100 billion in medical care, revenue lost by travel restrictions and capital flight from affected areas. The latest bird flu, H7N9, transmitted from animals to humans in China, is now said to be under control (cost: $6.5 billion) but the same is not yet true of a new coronavirus with origins in the Middle East that has already spread, human to human, to the UK, Germany and France. Harrison’s book is a reminder that even a rudimentary notion of the common medical good has been centuries in the making and is still far from universally accepted. Please turn your head when you cough.

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