Disease and Diplomacy in the 19th Century

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What began in a market in Wuhan, China, has spread as far afield as the Faroe Islands, and in response, a practice that began in a medieval republic on the Adriatic Sea is now official policy across much of the globe. Despite its boundless tendencies, the novel coronavirus has triggered a response from states that is largely protectionist, and reliant on a “batten down the hatches” approach to stem the spread. The measures have led some experts to predict the “end of globalization,” or at the very least, a future world in which governments retreat from a more globalized international system, in favor of more self-interested policies geared toward protecting their national citizens. But the history of nineteenth-century Europe suggests otherwise. Though disease ravaged populations, destroyed national economies, and often forced a reactionary protectionism, countries increasingly sought international agreement in an attempt to standardize their responses to pandemics. Moreover, certain domestic initiatives proved not only effective but also attractive to other countries facing similar challenges, a development which had wider implications for the conduct of international affairs at the turn of the century.

Neither the universalism of disease nor the nationalist tendencies that it provokes are new phenomena. In 1978, the French historian Emmanuel Le Roy Ladurie described what he referred to as “the unification of the globe by disease” between 1300 and 1600. It was a phrase he borrowed and adapted from the American historian Woodrow Borah, who had undertaken pioneering work on the demographic effects of the Spanish conquest in Mexico. A “common market of microbes,” Le Roy wrote, had been established, and as a result, the world had “passed through a particularly intense, rapid, dramatic, one might even say apocalyptic phase.” Into the nineteenth century, despite great advances in science and medicine, a slew of diseases continued to threaten national populations, which often impaired interstate relations. Not only were pandemics more numerous and more deadly than today, but swelling nationalist pride prompted many countries to respond with knee-jerk inward turns in the aftermaths of outbreaks.



But for all the nationalist sentiment, there was also a remarkable and unprecedented level of international cooperation. It is a development of modern diplomacy worth exploring in the present day, especially as governments begin to plan for the post-pandemic world. Cooperation in the period arose not out of Enlightenment-era tropes about the universal nature of man or odes to common humanity, but of economic and commercial necessity. In other words, the self-interest of each nation forced governments to cooperate, to standardize their individual responses to the global spread of disease. By the turn of the twentieth century, agreements and practices related to international health slowly developed, and they laid the foundation for the League of Nations Health Organization in 1924 and later the World Health Organization. As today, these systems never defined the international order of the nineteenth or early twentieth centuries — which was determined largely by military, economic and political forces — but they nonetheless provided incremental ordering mechanisms which helped to shape the wider international system. 

The Consequences of Quarantine

One of the more revealing experiences of the current pandemic has been the reliance on remedies from another historical era. Strategies of quarantine and lockdown, though heretofore rarely used in contemporary liberal societies, have come to be seen as an increasingly useful approach. Weekly directions from governments sound like something out of the Book of Leviticus: “All the days wherein the plague shall be in him he shall be defiled; he is unclean: he shall dwell alone; without the camp shall his habitation be.” Likewise, modern experience has an eerie similarity to that of the Athenians during the plague that struck in 430 B.C. As Thucydides wrote of the period,

Appalling … was the rapidity with which men caught the infection; dying like sheep if they attended on one another; and this was the principal cause of mortality. When they were afraid to visit one another, the sufferers died in their solitude, so that many houses were empty because there had been no one left to take care of the sick; or if they ventured they perished, especially those who aspired to heroism.

Practices during the fourteenth century, specifically in regard to quarantine measures between populations, would shape maritime interstate relations for centuries. Outbreaks of the plague between 1347 and 1377 led the Great Council of Ragusa, the political authority overseeing the port city in what is modern-day Dubrovnik, to issue a decree which held that all persons sick or suspected of infection were to isolate themselves from the city for 30 days. This practice of “trentino,” as it was then called, was eventually adopted by other port cities along the Mediterranean. Italian states such as Venice and Genoa then extended the period of isolation to 40 days, giving the practice its modern name “Quarantine” (from the Italian “quaranta” or ‘forty’).

Antiquated though these measures may seem, the practice of quarantine defined the relationship between disease and diplomacy for much of modern history. Yet toward the midpoint of the nineteenth century, as the industrial revolution significantly increased manufacturing within nations and the trade between them, both national and international opinions on quarantines found the practice ever more cumbersome and costly. After a particularly deadly outbreak of cholera in 1832, the British government implemented strict quarantine measures which drew the ire of English businessmen, traders, and merchants, leading some to argue that cholera was a “humbug got up for the destruction of our commerce.”

Likewise, on a regional and global level, the impact on trade and commerce was inconsistent and increasingly debilitating. The disparity in quarantine regulations meant that, as one historian has shown, a ship sailing from Constantinople to Marseille was required to quarantine for 60 days compared with 34 days had it sailed to Venice. The result was, by the 1830s, the first concerted push by European powers — most notably England and France — for a more standardized system of quarantine amongst states with ports along the Mediterranean. One way of doing this, French leaders suggested, was to decide “in concert” on a uniform system. British officials largely agreed, with one official adding, “It will be rendering a great service to society at large, if the application of quarantine can be reduced to a rational and uniform system, instead of continuing, as at this moment, an ample field for fanciful fear and caprice.” In the end, the proposed conference never took place, in part due to differences between Austria and France over which country would host the meeting. In what would prove a recurring theme at various points during the century, political interests often trumped concerns over cooperation on health.

Diseases and the crippling responses they provoked continued to weigh on European governments, many of which continued to reap the benefits of mass industrialization and increased maritime trade. Indeed, by the midpoint of the century, over 90 percent of the world’s shipping was European or American, a reality that fed into perceptions that innovation and prosperity were seemingly boundless. This optimism, reflected by the 1851 Great Exhibition in London — “the greatest human assemblage ever collected together upon one small spot of the earth’s surface,” as one journalist reported —contrasted sharply with the return of cholera to Europe in the same period. As the disease once again spread throughout the continent and protective regulations began to stifle trade, leaders such as Louis-Napoléon Bonaparte wrote that quarantine measures were beneficial to public health, but equally, “their excessive use hinders the freedom of our international relations … and cause[s] great damage to French trade.”

Science, Self-interest, and the Internationalist Urge 

The need to resolve this uncomfortable strain between pandemic on the one hand, and progress and prosperity on the other, was one of the reasons European governments once again advocated for nations to cooperate on matters relating to the spread of disease. Due largely to French initiative, the first International Sanitary Conference met in Paris beginning in July 1851. For over six months, medical and diplomatic representatives from twelve countries — including Turkey and several independent Italian states — sought to standardize quarantine measures related to cholera, yellow fever, and the plague. Though a landmark for modern medicine and diplomacy, the meeting ended without agreement, and thus laid bare both national and international divides. It would take 41 years and six more conferences — there were a total of 14 between 1851 and 1938 — until representatives reached a substantive agreement on an international convention.

As scholars have shown, one of the biggest hindrances to international cooperation was the inability to agree on scientific research into the nature and transmissibility of certain diseases. When it came to cholera, debates ranged from whether it was waterborne, transmitted more by land or sea, or if it could spread between individuals. The most well-known divergence, however, was between so-called “contagionists” and “anti-contagionists.” The divide was such that two of the leading medical bodies within Britain were split, with the Royal College of Physicians believing that the disease was spread between individuals and the General Board of Health arguing that it was the result of dire sanitary conditions. There were also differences between government officials and scientific experts, which ended up playing out on the international stage. At the conference in 1851, the British medical representative, feeling that quarantine regulations were useless, voted against his own government’s position on the origins of cholera.

As the historian Peter Baldwin has pointed out, responses to the spread of disease, whether cholera, plague, or syphilis, depended on factors ranging from political tradition, geography, and the wealth and administrative capacity of the state. Broadly speaking, Mediterranean nations such as France, Spain, Italy and Greece, favored more traditional quarantine measures, the likes of which had been in place for centuries. Britain, on the other hand, leaned towards anti-contagion and thus was more resistant to strict quarantine measures, a position which sat comfortably with its status as the world’s preeminent trading nation. Crucially, authorities within Britain began to devise more efficient regulatory measures at ports throughout the country. Between the 1850s and 70s, as quarantine measures continued to hinder the flow of British trade, officials in ports across England replaced indiscriminate blanket quarantine measures with more targeted techniques which involved inspection of ships, isolation of sick passengers and tracking of infected persons. Known as the “English system,” this method proved effective and far more efficient, and toward the end of the century, a number of European nations adopted similar techniques.

Aside from the influence of opposing scientific opinions and diverging domestic responses, the interplay between disease and diplomacy during the nineteenth century was also the product of political differences, some of which were colored by national prejudices. Not only was there “complete anarchy” with regard to quarantine regulations, as the Italian foreign minister put it in 1885, but as Baldwin notes, “each nation had its favourite epidemiological whipping boy: Poles and Galicians for the Germans, Russians for the Swedes, Irish for the English, Spanish for the French, Catholics for Protestants, while … everybody feared the [so-called] Orient.” The Indian origins of several cholera outbreaks meant that European governments directed their anger not only eastward but also toward the United Kingdom, India’s colonial ruler. At the 1894 conference, for instance, a French representative declared that the British government “has the responsibility of opposing [cholera’s] exportation.”

A number of European nations came to see two choke points — the annual pilgrimage to Mecca and the Suez Canal —as the key to controlling future outbreaks. As early as the third conference in 1866, Britain and France pressured the Ottoman Empire to take concrete measures to prevent the spread of cholera into Europe. In subsequent conferences, the Suez Canal, opened in 1869, became a sticking point, as several European powers believed that careful administration of the narrow waterway could prevent the spread of disease. Britain, on the other hand, was against any measures imperiling its freedom of movement, arguing that no ships travelling from India to Britain should stop for any matters related to health. One British newspaper speculated that such controls would be solely for political reasons: “So many incidental interests are involved in anything relating to the Suez Canal that science can hardly be expected to find itself paramount in any conclusions that may be arrived at.”

On another level, scientific advances were also seen to be in the service of imperial administration, as well as an increasingly useful tool in the so-called “scramble for Africa.” As late as the turn of the twentieth century, the United Kingdom established the Liverpool and London Schools of Hygiene, both of which were created, in part, to discover cures to infectious diseases which originated in colonial territories. The link between medicine and imperial power was explicit in many cases. Sir Ronald Ross, a malaria specialist and the recipient of the Nobel Prize for medicine in 1902, was said to have “added many acres to the Empire” and himself spoke of “the success of empire” being closely linked to “success with the microscope.” Elsewhere, the British Colonial Secretary Joseph Chamberlain framed the schools of hygiene as representative of “national pride and imperial patriotism.”

The Move Toward International Organization

Despite the increased intensity in international competition throughout the 1890s, a number of governments found it in their immediate interest to cooperate with one another. As these peripatetic sanitary conferences continued to meet, delegations signed international conventions addressing a range of issues, from the standardization of quarantine measures to a pledge to notify others in the event of a national outbreak. The alignment of views was the result of two developments in particular. First, there was more agreement on scientific facts, especially around the spread of diseases. The contagionist versus anti-contagionist debates, which had occupied national and international discourse, were largely resolved by the final decades of the century. Cholera was finally accepted as a waterborne disease, which could be avoided with improvements in sanitation, especially within cities. Second, effective measures undertaken by the United Kingdom served as an attractive model for other countries. Concerns over continued commercial disruption, in particular, forced British officials to change their methods of corralling the spread of disease, and the what came to be known as the “English system” became the preferred practice in Europe, as governments found it medically effective and economically efficient.

Despite the ongoing rivalries and political maneuverings which marked the last decade of the nineteenth and first decade of the twentieth centuries, the agreements reached in previous decades helped to prepare the foundation for the first modern international organizations related to global health. The establishment of the Pan-American Sanitary Bureau in 1902 and the Office International d’Hygiène Publique in 1907 allowed for better coordination of interlinked activities, from research into etiology and vaccinations, to tracking the outbreak and spread of disease. Though the League of Nations Covenant hardly mentioned global health — with the exception of Articles 23 and 25, the former committing League members to the “prevention and control of disease” — the League itself took the subject seriously. At the second meeting of the League Council in April 1920, members addressed the outbreak of typhus and cholera in Eastern Europe, a challenge that was compounded by a refugee crisis in Greece. An Epidemics Commission was quickly set up, and later, in 1924, the Health Organization of the League was formally established. As the historian Charles Webster wrote of these structures, they were not designed to “supersede governments but to supplement them, to do for them all what no one of them could do for itself.”

History as a Guide to Shaping International Order

The relationships between disease, science, nationalism, and internationalism in the nineteenth and early twentieth centuries have been highlighted by a number of historians in the past; yet these linkages seem to be undervalued by a number of commentators today. On the subject of international order, in particular, the pessimism of some leading thinkers is discouraging. Thomas Wright has argued that “No historical lessons will guide the world this time,” while Richard Haass has written that, “Ideally, the crisis would bring renewed commitment to building a more robust international order… [but] the world today is simply not conducive to being shaped.”

A look to history reveals that, in these moments of perceived upheaval, opportunity for ordering is, in fact, as present as ever. For leading governments interested in the task, the international system is always conducive to being shaped, but it’s a question of whether that system is one built on cooperation or competition, on visionary expanse or pragmatic settlements, on ethical or rudimentary conceptions. Some mix of these will undoubtedly exist, but it’s in the purview of statesmen and women to strike the balance in the midst of contemporary realities.

The “unification of the globe by disease,” as Le Roy Ladurie framed it years ago, continues to necessitate a degree of international cooperation, for the sake of health as well as commerce. It was a reality that governments such as France and England understood they needed to address “in concert,” as opposed to unilaterally. This nineteenth-century precedent offers useful insight for the present day. Unless autarky is the aim, individuals and nations will travel, trade, and produce on a regional and global scale. Matters pertaining to health will require a renewed internationalist urge. Coordinated reporting and tracking of infectious disease, shared research into vaccines, and standardization of shutdown regulations are all examples of ways in which governments can cooperate to save their citizens and stave off painful economic downturns. As in the nineteenth and early twentieth centuries, international collaboration related to health will not define the international system in the coming decades, but it will undoubtedly nudge it in important ways.

Equally important is an understanding that the demand for best practices means that, in the current environment, countries large and small can play an outsized role in shaping the approaches of other nations. Just as the “English system” of the 1870s served as a model for other countries desiring a change from the traditional methods of quarantine, the decisions taken by governments today can set standards among regional and international actors. The Czech Republic, for example, with its ability to contain the spread and thereby begin to reopen businesses, has caught the attention of British ministers. Elsewhere, the methods of South Korea, Taiwan, Australia, and New Zealand — countries which endured painful, though valuable, experiences from other recent regional epidemics — can serve as examples for countries across the world. The ability of governments, especially those with more liberal governance traditions, to enact measures which are medically effective, economically efficient and limitedly intrusive will, along with an openness to future international collaboration, say much about the nature of the global order going forward.



Andrew Ehrhardt is a post-doctoral fellow with the Engelsberg Applied History Programme at King’s College London.

Image: Wellcome Images


CORRECTION: A previous version of this article contained an error in a quote. Emmanuel Le Roy Ladurie wrote of the “unification of the globe by disease,” not “unification of the world by disease.”