Quarantine and Enlightenment: ‘Following the science’ in eighteenth-century Europe

Danilo Samoilovich (Samoïlowitz), Mémoire sur la peste

Danilo Samoilovich (Samoïlowitz), Mémoire sur la peste (Paris, 1783), title page.

‘Nous étions au XVIIIe siècle, qui est celui des Sciences et des Arts’, proclaimed Danilo Samoilovich in his Mémoire sur la peste (Paris, 1783, p. xviii). Dedicated to Catherine the Great, it was an account of his experiences as a physician during the great plague of Moscow in 1770-1771. It was also a tribute – in the most ‘enlightened’ of all centuries – to ‘the enlightened doctors of Europe’ who had discovered that plague was contagious, and could only be caught by contact with infected persons or substances. As a result, and under the guidance of an enlightened ruler, quarantine lines had been erected around plague-stricken Moscow. They had contained the disease there, and protected St Petersburg from infection. Once a cordon sanitaire had been established, Samoilovich concluded, plague ‘could not cross the limits fixed for it by the government’.  Containment worked when backed by ruthless political action.

When I came across this passage while working on plague in the eighteenth century, I thought it might interest historians of the Enlightenment; and I was reminded of it again when I read the recent blog by Cindy Ermus on ‘Leadership matters…’ (3 April 2020) which focuses on the plague epidemic of Marseilles in 1720-1721. The Moscow example certainly shows that leadership mattered there, but the Marseilles plague is also relevant because it demonstrated that Samoilovich was wholly wrong to think that all the enlightened doctors of Europe agreed that plague was contagious and quarantine necessary. In the 1720s physicians in France were deeply divided between contagionists and anti-contagionists, many of the latter from the famous medical school of Montpellier, and several of those who worked in Marseilles were eager to air their disagreements in print. Consequently, when Gabriel-François Venel came to write the authoritative article on ‘Contagion’ in volume 4 of the Encyclopédie (first published in 1754), he was compelled to declare that there was no issue more uncertain and divisive ‘in medicine than the existence or non-existence of contagion’.

Daniel Defoe, A Journal of the plague year

Daniel Defoe, A Journal of the plague year (London, 1722).

It had been equally divisive in England in the 1720s in debates between advocates and critics of a new Quarantine Act, introduced by Walpole’s government to be implemented if plague arrived from Marseilles. There should be a military cordon sanitaire around London, and the infected and their contacts were to be moved from their homes and isolated elsewhere. Under public pressure the most intrusive parts of the Act had to be repealed, but that did not stop a major controversy in the public press between contagionists and their opponents, in which Daniel Defoe proved his stature as journalist as well as novelist by not only writing a journal of an earlier plague year, but seeing the virtues and vices of both sides. It had to be accepted, Defoe insisted, that ‘a public good’ sometimes justified ‘private mischief’. In a plague, something had to be done by government to prevent more death and disorder.

It was the presumption of contagion, therefore, rather than the proof of it which provided political authorities with what ‘scientific’ justification they had for action in eighteenth-century Europe. It seemed plausible enough, given the concentration of disease in identifiable households and neighbourhoods, and that was sufficient to justify elaborate and expensive efforts at containment, not only in France and Russia, but in Germany and Scandinavia where there were major epidemics in the first decades of the eighteenth century. Like their predecessors in the seventeenth century, rulers of empires, kingdoms and city states were all eager to show that they were doing more than their neighbours and doing it more successfully. As in the present pandemic, subjects and citizens were assumed to need reassurance that their rulers were more effective, and indeed more ‘enlightened’, than their rivals.

A plague doctor, in Jean-Jacques Manget, Traité de la peste

A plague doctor, in Jean-Jacques Manget, Traité de la peste (Geneva, 1721), frontispiece. (Google Books)

This is not to say that they did not have some reputable medical authorities on their side, of course. In the 1720s, for example, the advocates of contagion included a major authority on plague, Jean-Jacques Manget of Geneva, who published a short treatise expounding his case. It had as its frontispiece one of the earliest illustrations of the protective uniform worn by plague doctors, in France and elsewhere. With its mask complete with a beak for holding herbs, it was a powerful statement about infection. According to Manget, it was worn by some of the anti-contagionist physicians from Montpellier in Marseilles, and something very like it was recommended for the confirmed contagionist physicians in Moscow in 1771. Like quarantine, masks as ‘personal protection’ against contagion have a long history.

As long as plague remained a real and present threat to Europe, the presumption of contagion and all it implied remained powerful. Early in the nineteenth century Russia was erecting land and maritime quarantine stations in the Black Sea region in order to defend its empire from infection from further East. In western Europe, which had scarcely seen plague for half a century, some governments felt better able to relax their vigilance, partly at least because they were under pressure from commercial interests wanting less quarantine not more. Even so, the relaxation was a very slow process.

Bonaparte Visiting the Pesthouse in Jaffa, by Antoine-Jean Legros

Bonaparte Visiting the Pesthouse in Jaffa, by Antoine-Jean Legros (1804).

One significant marker of changing perspectives is the famous picture of 1804 showing Napoleon in a plague hospital in Jaffa in 1799. He is portrayed touching the plague bubo of a patient, a gesture probably copied from one of the Montpellier-trained physicians practising in Marseilles in 1720, who wanted to prove that contagion held no terrors. In 1804 it was no doubt intended to show the superiority of Western science, and that plague presented no threat at all, at least to Europeans. Bonaparte had nothing to learn from modern world leaders about the political utility and propaganda value of a grand gesture, preferably supported by a little modern science.

In present circumstances some politicians in the UK claim to have been ‘following the science’ in their policies against a pandemic. That has never been as easy as it sounds. The history of plague is full of disputes where the experts – physicians in this case – were deeply divided. Since nothing at all was known about how plague was transmitted, about its dependence on rats and fleas, for example, argument was inevitable. In the case of Corona, the scientists know vastly more about their target. But even then they cannot always be unanimous in their judgements on the balance of probabilities when it comes to interventions whose outcome depends upon the behaviour of crowds as well as individuals. Then all action is political, and when the experts are divided about appropriate action, as they must often be, the quality of political leadership matters all the more.

– Paul Slack

Voltaire’s Letters on the English and the story of smallpox

‘It is inadvertently affirmed in the Christian countries of Europe, that the English are fools and madmen. Fools, because they give their children the small-pox to prevent their catching it; and madmen, because they wantonly communicate a certain and dreadful distemper to their children, merely to prevent an uncertain evil.’

Letters concerning the English nation

Title page of Letters concerning the English nation, London, 1733.

Here is Voltaire explaining inoculation to the French, quoted here in the translation Letters concerning the English nation, first printed in London in 1733 (published in French as the Lettres philosophiques). Voltaire lived in London between 1726 and 1728, and it is then that he learned at first hand about the English practice of inoculation. He decided, perhaps surprisingly, to include a letter on the subject in his Letters on the English, a work begun in London and published a few years later when he was back in France.

Letter 11, ‘On Inoculation’, is on the surface a description of how the English have embraced a modern medical technique then regarded with huge suspicion in France. But at its heart, this is a morality tale about the tension between empirical evidence and superstition, and that makes the letter seem a whole lot more topical. In her recent blog post, Leadership matters in the first days and weeks of an outbreak: lessons from the Great Plague of Marseille, 300 years later, Cindy Ermus wrote graphically about the outbreak of plague in Marseille in 1720, drawing uncomfortable parallels between the management of the crisis then and now. Voltaire’s letter on inoculation similarly acquires unexpected resonance in the context of the present crisis.

Le célèbre docteur Ane voulant introduire la mode de l'inoculation

Le célèbre docteur Ane voulant introduire la mode de l’inoculation, à Paris (c. 1784-1785). (BnF/Gallica)

The practice that Voltaire is describing is now strictly called variolation, and involves inoculating with the smallpox virus; inoculation with cowpox, that is vaccination, was a safer method introduced by Edward Jenner and others from the 1760s. Variolation was practiced widely in China, from where it spread to the Ottoman Empire and then to Europe. The first European country to take up variolation was England, where the practice became common from the 1720s, precisely the time when Voltaire was living in London.

Voltaire would have seen at first hand that even in England, inoculation was still mistrusted, and he uses what we would now call evidence-based argument to show the brute statistics of death. Modern journalists are currently talking a lot about the economic damage caused by the present pandemic, and the challenge of weighing human life against the health of the economy. Voltaire is in his time perhaps unusual in understanding that there is a link between a health crisis and a country’s commercial interests: ‘A trading nation is always watchful over its own interests, and grasps at every discovery that may be of advantage to its commerce.’

Lady Montagu in Turkish dress, by Jean-Etienne Liotard

Lady Montagu in Turkish dress, by Jean-Etienne Liotard (c.1756).

The most human note in Voltaire’s letter on inoculation is when he talks of the courage of Lady Mary Wortley Montagu, ‘a woman of as fine a genius, and endued with as great a strength of mind, as any of her sex in the British kingdoms’, who learned of inoculation in Constantinople (where her husband was British ambassador), and introduced the practice in England, with the active support of the Princess of Wales, Caroline of Anspach – ‘this Princess’, writes Voltaire, ‘born to encourage the whole circle of arts, and to do good to mankind’. The Letters on the English present a world of politics, science and literature that is predictably male-centred, and the letter on inoculation is a refreshing exception in presenting two remarkable female protagonists. And there have been journalists recently suggesting that many of the countries having most success in the fight against Covid-19 are those led by women…

Voltaire mentions in his letter the particularly severe epidemic that had swept Paris just a few years before he came to England: ‘Twenty thousand persons whom the small-pox swept away at Paris in 1723, would have been alive at this time’, he writes – no exaggeration, since modern historians put the figure at closer to 40,000 deaths. But what Voltaire does not say is that he experienced this epidemic at first hand. His close friend Génonville died of smallpox in September 1723, and in late October he went to stay with the président de Maisons at his house outside Paris, known nowadays as the château de Maisons-Laffitte (a beautiful baroque house designed by Mansart). From there he wrote to his friend the marquise de Bernières saying that ‘Paris is ravaged by this illness’ (30 October 1723), and listing their common friends who had died. Then Voltaire himself was diagnosed with smallpox, and he became dangerously ill, too ill to be moved. His friends feared for his life, a doctor was summoned from Paris (who apparently bled him copiously), and several weeks passed before he was out of danger. Finally, Voltaire was fit enough to leave the château de Maisons, and just as he left, a huge fire broke out, destroying a large part of the house: Voltaire’s visit to Maisons was not one his hosts quickly forgot.

Château de Maisons-Laffitte, by Jacques Rigaud

Château de Maisons-Laffitte, by Jacques Rigaud (1681-1754).

No sooner was Voltaire back in Paris than he got down to work. On the principle that you should never waste a good crisis, he wrote a poem addressed to Gervasi, the doctor who had, as he thought, saved him, and another poem to Mlle Lecouvreur, the great actress who had been present at Maisons when he was taken ill. He also wrote a letter to the baron de Breteuil (c. 5 December 1723), describing in fulsome detail the course of his illness; and then another anonymous letter appeared (c. 10 December 1723), apparently written to Voltaire by a fervent admirer, lauding the heroism of the poet, ‘truly the only poet’ in France, for having worked even during his illness. Voltaire could not have written a more glowing eulogy himself, and in fact that does seem to be what he did – forge a fan letter. These four pieces have long been known, but separately, and it was only when they were edited in the Oxford Complete Works of Voltaire (volume 3A, 2004, p.256-76) that we were able to understand for the first time that this amalgam of two prose letters and two poems was constructed deliberately as one single literary work, an epistle in prose and verse that Voltaire published in the Mercure de France in December 1723. The young ambitious poet had been out of the limelight for too long, and he was anxious to remind the literary world of the capital that he was back in Paris and in business – and his recovery from smallpox was a good story to tell.

What is interesting, to return to the Letters on the English, is that Voltaire does not tell that story here. This is a book written directly out of his experience of English life, but Voltaire never, ever, tells us everything. The Complete Works of Voltaire were begun in 1968, and the Voltaire Foundation plans to celebrate the completion of the 203 volumes at the end of 2020. When we chose the Letters on the English as the last major text to appear in the collection, we could not have known it would have this contemporary resonance. But Voltaire’s Enlightenment voice continues to resonate, powerfully, and often in ways we don’t expect.

– Nicholas Cronk

A (sacred) contagion

Les pestiférés de Rome by Alphonse Legros

Les pestiférés de Rome (c. 1855-1877), by Alphonse Legros. (BnF/Gallica)

You feel as though you are in danger. You know that what is threatening you is all around you and invisible. You feel precarious on this earth. When you look at the world out there, you are worried. Disorder makes you anxious, order reassures you. When you think of the days ahead, you find yourself in a state of bafflement; your mind vacillates between the fear of pain and disgrace and the hope for health and prosperity. At times of weakness or when your loved ones are exposed to risk, fear dominates. When they are safe, and you are feeling well, hope prevails. You are constantly suspended between opposite states of mind. Everything about your future and the future of your community seems unpredictable. You live in a constant state of emergency. Every day, you join your fellow citizens in lugubrious rituals where you remember the dead and celebrate the living, thank saviours and honour martyrs. You feel powerless. You do not understand; you know so little of the causes of your uneasiness. You wonder what they look like, where they reside, where they are from, how they affect you, when everything started, who was first affected, when misfortune will be over, and everything will be all right again. You have no answers.

Baron d’Holbach’s La Contagion sacrée

Title page of Baron d’Holbach’s La Contagion sacrée (1768).

But you realise that someone else knows more than you do. They do not have all the answers, but they do understand more than you, they are more acquainted with the invisible causes than you are, they have learned more. You trust them. You are scared. You have no choice. When their decrees are announced, you submit without a murmur; you adopt, without examining them, the prescribed ways of rendering the invisible agents harmless. You now follow their prescriptions methodically, ceremonially: you wear what they recommend, you purify your body according to their instructions, you move in the ways they endorse, in the places and times they have established. Sometimes, even those who have knowledge disagree, debate, fight battles, divide into sects. You doubt, sometimes. You do not like sects, perhaps. And yet you are scared. You do not know. You obey. You have no choice.

You are an inhabitant of this planet in the spring of 2020. You are also a believer from any time or place, according to the baron d’Holbach. Gods and goddesses may seem less real than viruses, but that does not mean they are less dangerous than a plague. The ghosts of religion and superstition can affect human life as much as a disease does. It is when fear meets ignorance and imagination, though, that the disease turns into an epidemic, a true ‘sacred contagion’: ‘fear is the most contagious of all passions’.

– Laura Nicolì

Laura Nicolì (Voltaire Foundation / LabEx OBVIL, Sorbonne Université) is currently working on the born-digital critical edition of Paul-Henri Thiry d’Holbach’s La Contagion sacrée ou Histoire naturelle de la superstition (1768), in the context of the Digital d’Holbach project.

Leadership matters in the first days and weeks of an outbreak: lessons from the Great Plague of Marseille, 300 years later

It seems as though American society has all but ground to a halt: all sporting events postponed or canceled, Broadway shuttered, entire states closing schools and businesses, and issuing stay-at-home orders. While these tactics may seem extreme, the goal is to “flatten the curve”, or prevent local outbreaks of the COVID-19 from overwhelming our medical system and exacerbating a once localized crisis.

This year, we mark the tricentennial of an important event in the history of infectious disease, one that carries many lessons for us today as we assess the threat of the novel coronavirus in the United States, and debate the extent to which we must impose such social distancing and interrupt the daily routines of millions of Americans.

On May 25, 1720, a ship named the Grand Saint-Antoine, which had journeyed for nearly a year in the eastern Mediterranean, arrived back at the port of Marseille, France carrying bales of cotton, imported fine silks and other valuable goods destined for the foire de Beaucaire, one of the most important trade fairs in the Mediterranean. Unbeknownst to those on board and on land, it also carried the bacteria that causes plague. Within two years, as much as half the population of the port city had succumbed to the infection.

Eighteenth-century engraving of the Foire de Beaucaire. Musée de Nîmes.

Eighteenth-century engraving of the Foire de Beaucaire. Musée de Nîmes.

The Great Plague of Provence, or Great Plague of Marseille, brought southern France to its knees, and led much of the rest of the world to impose strict measures to prevent its spread. Understanding how the outbreak was mismanaged in its earliest days reveals that human actions and inactions can turn what begins as a local outbreak into a rampant pandemic. The key lesson for us today: we must demand more from our leaders than we have received to date, and they must prioritize containing the pandemic over everything, including economic well-being.

About two months prior to the arrival of the Grand Saint-Antoine in Marseille, a passenger died of what appeared to be bubonic plague days after boarding the vessel at Tripoli. Soon thereafter, another seven or eight men, including the ship’s surgeon, are said to have died on the route from Tripoli to Livorno, where Captain Jean-Baptiste Chataud made an emergency stop before heading back to Marseille. In this time, another three likely perished from plague.

Even so, local Italian doctors inspected the ship and declared the illness a case of pestilential fever rather than plague. As a result, authorities in Livorno allowed the ship to depart for Marseille with a patente nette, or certificate of health, that declared it free from infection, and the ship’s captain – who was reportedly in a hurry to get back to Provence in time for the trade fair – was more than happy to depart.

Upon the vessel’s arrival in Marseille, the ship endured an unusually short quarantine – only a few days, rather than the full term of about six weeks – despite the deaths that took place on board. Jean-Baptiste Estelle, the city’s premier échevin, or municipal magistrate, who owned part of the ship and a large portion of its cargo, had used his influence to arrange for the premature unloading of his shipment into the city’s warehouses – already infected with the bacteria, Yersinia pestis – so that they could be sold soon thereafter at the trade fair.

Dramatic scenes of suffering along Marseille’s Cours Belsunce during the Great Plague of Provence.

Dramatic scenes of suffering along Marseille’s Cours Belsunce during the Great Plague of Provence. Vue du Cours pendant la peste de 1720, by Michel Serre (1721). Musée des Beaux-Arts de Marseille.

Meanwhile, however, the signs of plague were becoming unmistakable as it claimed more victims. Several porters who had reportedly handled the ship’s merchandise fell ill and perished within two to three days. At this time, a local surgeon was called to inspect the bodies and determine the cause of death. Only then was the ship redirected to the quarantine station on the island of Jarre. But it was too late – plague had arrived in Marseille.

And yet, despite people purportedly “dropping like flies” according to one local eyewitness, rather than undertaking emergency measures to contain the plague, officials instead launched a major and elaborate campaign of misinformation. Local authorities hired doctors (for a large sum of money) to diagnose the local distemper as merely a malignant, pestilential fever, and thus, not plague. The reason? Money and feckless leadership. At stake was both the reputation of the city’s leaders, and more importantly, the livelihood of this ancient port city, which by the 18th century had become a major commercial capital.

Another representation of the plague in Marseille by Michel Serre. It depicts the city’s hôtel de ville with scenes of death and dying in the foreground.

Another representation of the plague in Marseille by Michel Serre. It depicts the city’s hôtel de ville with scenes of death and dying in the foreground. Vue de l’hôtel de Ville de Marseille pendant la peste (1721). Musée des Beaux-Arts de Marseille.

Amidst rumors throughout Europe, and fearing the consequences that a plague epidemic could have on Marseillais commerce, the city’s leaders and the Bureau of Health sent letters in July 1720 to the Regent in Paris, as well as to health officers in ports all over Europe, stating that local authorities had managed to contain the contagion. But they hadn’t. A full two months after the beginning of the outbreak, when plague in Provence could no longer be refuted, French authorities finally suspended all commerce out of Marseille, quarantined the city (and later the entire region), and put a number of measures in place to prevent the spread of the epidemic.

Unfortunately, however, thanks in part to the lies of local officials, it was too late. The epidemic had already begun to spread throughout the region of Provence, where it ultimately took as many as 126,000 lives.

In those first crucial weeks after the start of the outbreak, Marseillais authorities prioritized economic interests over public health. As a result, what began as a few dead aboard a ship became a virulent epidemic that raged in southeastern France for two years.

Such negligent misdeeds are all too familiar to us today. The first several weeks of the current health crisis saw the President of the United States, and his backers in the conservative media, refer to the novel coronavirus as a hoax, part of a conspiracy to destroy his presidency. Much like Marseille’s officials in 1720, the current administration claimed, incorrectly, that the virus has been contained. The president has also wrongly insisted that sick people should go to work, and that “anyone who needs a test gets a test.”

In an effort to downplay the pandemic, he ignored the advice of the CDC that the elderly avoid large crowds and long trips. And on March 11, his Oval Office speech – key parts of which his administration later scrambled to clarify – all but proved to the American people, and the world, that the president cannot be trusted to sensibly and effectively manage the current crisis.

Much as in 1720, the administration’s failure to act prudently in the earliest days of the coronavirus outbreak has resulted in an emergency that is now more difficult to predict, to track, and to contain.

Not for the first time, we are witnessing a breakdown of institutions that we would otherwise trust in times of crisis. Inept leadership and a campaign of misinformation helped turn yet another disease outbreak into a full-blown emergency.

In times of public health crises, and especially in those crucial early days of a new outbreak when concentrated, steadfast measures are essential, the quality of leadership matters.

– Cindy Ermus

Cindy Ermus is assistant professor of history at the University of Texas at San Antonio, and executive editor for the online journal, Age of Revolutions. She is currently completing a book on the Great Plague of Provence. Follow her on Twitter @CindyErmus.

A version of this article first appeared in The Washington Post under the title, “The danger of prioritizing politics and economics during the coronavirus outbreak: Three hundred years later, the lessons of the Great Plague of Provence are sounding an alarm.”