Using the UK Medical Heritage Library to explore 19th century experiences of epidemics, contagion, and quarantine.
This post is written by William Wood, Senior Library Assistant at the Foyle Special Collections Library, King’s College London.
The passing of time is something that all of us have become intimately familiar with. In 2020, we watched its slow advance, isolated behind closed doors, as the seasons around us and the circumstances we found ourselves in changed and changed again. It was the poet Jon Bon Jovi who taught us though, that the more things change, the more they stay the same. This sentiment could not have been clearer to me than when I began to compare the experiences of those who suffered through pandemics in the 19th century with our modern-day experiences of the novel coronavirus, Covid 19. The centuries may separate us, but they do little to obscure the natural human responses to a tragedy of this magnitude.
In this blog post, I will be highlighting items from the Foyle Special Collections Library, King’s College London that were included in a major digitisation project that gathered books and pamphlets from research libraries across the UK. King’s College London was one of ten partners who, jointly funded by Jisc and the Wellcome Trust, worked to create the UK Medical Heritage Library,a repository of approximately 15 million pages and 70,000 volumes of material, focussing specifically on the 19th and early 20th century history of medicine. This online collection is a marvellous resource for students and academics and provides insight on the extent of medical thought and practice at a time when humanity was faced with the spread of diseases such as typhus, yellow fever and cholera. A link to all the King’s College material digitised for the project is available here
The phrase ‘hindsight is 2020’ has become synonymous with the year itself when considering the alternative ways world governments responded to the virus and the varying levels of success that they had. It is easy to question and be critical of decisions that were made in the early stages of the pandemic now that we are so painfully aware of the ramifications of not acting quickly enough. The claim that no one could have foreseen these difficulties is also hard to believe when you consider the hundreds of years of documented history concerning plagues and pestilence. We can easily see the shadow of our present written in the pages of the past:
A further character of great Epidemics … is this:—they are actually present and in operation some time before they assume their distinct and proper form….Hence doubt is sometimes reasonably entertained of their true character. When at length increasing numbers leave no doubt of the actual presence of the dreaded malady, the first announcement of it is always received with incredulity and sometimes with resentment ; and so it is that Epidemics always take a country by surprise—burst suddenly on an unprepared people, who wilfully shut their eyes against the plainest evidence, as if they would avert the event by denying its existence.(Smith, p.7-8)
The excerpt above is taken from Thomas Southwood Smith’s, The common nature of epidemics, and their relation to climate and civilization which was published in 1866. His final phrase, while accusatory, also recognises the havoc that fears and anxieties can play on people’s minds and acknowledges the very human response to crisis, which is to hope it just goes away on its own. We know, as they did, that for circumstances to be changed, action must be taken. In March 2020, prime minister Boris Johnson began his daily press briefings, urging everybody in the UK to work from home and avoid pubs and restaurants to give the NHS time to cope with the pandemic. Days later, in a televised address to the nation, lockdown was enforced and Britons were told they should only go outside to buy food, to exercise once a day, or to go to work if they absolutely could not work from home.
Much, however, may be done, even in these difficult circumstances, by following the same principles of prudence, and by avoiding all unnecessary communication with the public out of doors : all articles of food or other necessaries required by the family should be placed in front of the house, and received by one of the inhabitants of the house after the person delivering them shall have retired.(Smith, p.62)
The practice of quarantine too was already a familiar one in the 19th century as it had been used since the 14th century to protect coastal cities from the plague. The word quarantine is derived from the Italian quaranta giorni meaning 40 days and indicated how long contaminated ships must remain at anchor before disembarking. The following excerpt shows that medical practitioners were well aware of the importance of monitoring a disease throughout its entire lifecycle before making recommendations on the length of isolation periods:
Until the time during which the contagion of cholera lies dormant in the human frame has been more minutely ascertained, it will be necessary, for the sake of perfect security, that convalescents from the disease, and those who have had any communication with them, should be kept under observation for a period of not less than twenty days.(Smith, p.62)
Isolation can be difficult and finding the motivation to focus on your health and well-being can be even harder. You might find some small comfort in knowing then that your lack of healthy habits is not a modern problem. People throughout history struggled with vices and with keeping themselves, their families and their houses clean and tidy. The following passages will either remind you that you are not alone or they’ll feel like you’ve been caught in front of the fridge for the umpteenth time, knowing full well it was still empty, before returning to your nest of unwashed blankets and flickering screens.
Deficient or unwholesome food or drinks, a humid and foul locality, filthy habitations, depraved habits, excessive cold or heat, not duly guarded against, all conjoined may not at once produce disease, but they will insensibly undermine the healthy resistile power, thereby exposing the body to epidemical influence, from which otherwise it had been comparatively secure.(Collier, p.13)
Intemperance was a national vice. Excessive carousing at home, or days and nights spent in taverns, was the usual practice among all classes, and the physical and moral evils resulting from the custom were neither redeemed nor lessened by the epithet which these habitual convivialities appear to have conferred upon the nation of “Merrie England.”(Smith, p.37)
In April 2020 we saw many countries close their terrestrial borders and watched as the airline industry cut 90% of its flights in Europe. In order to slow the spread of the disease, world governments had to work together to limit the movements of the people. Lockdowns and enforced isolation naturally had follow on effects with supply chains and the distribution of goods.
All intercourse with any infected town and the neighbouring country must be prevented, by the best means within the power of the magistrates, who will have to make regulations for the supply of provisions.(Smith, p.62)
Travel restrictions were simply not enough and further steps needed to be taken in the fight against Covid-19. Strict local measures were required and so by 15 June the UK had made masks compulsory on public transport and by July they also needed to be worn in indoor spaces. Masks and other personal protective equipment allowed individuals to mitigate contact with others and access essential public spaces such as supermarkets and post offices more safely.
Visitors and attendants should also avoid the direct current of his breath, or the exhalations from his body, or from his evacuations ; or, if obliged to come into close contact with them, should maintain a temporary suspension of the breath.(Bateman, p.153)
For many, the enforcement of masks had come too late and felt especially ineffective when you considered the small but vocal minority of anti-mask protesters who felt their civil liberties and rights were being eroded by being forced to wear a mask in public. These voices were unsurprisingly loudest of all in the land of the free, a nation then led by an individual with strong and contentious opinions. In fact, president Donald Trump’s promotion of unfounded and dangerous medical advice resulted in the need for a warning which stated that no, bleach should not be consumed or injected for its antibacterial properties. Perhaps if he had read the following excerpt from Collier’s, The code of safety, or, Causes, effects, and aids, preventive and curative, as well of other epidemics, as also of Asiatic cholera, his suggestions may have been even more outlandish and dangerous but at least they would have been backed up by medical reasoning, albeit from 1849.
With regard to disinfectants for the effluvia of jail or typhus fever, English evidence is chiefly in favour of the gas given off by pouring about an ounce of oil of vitriol upon a handful of saltpetre, heated in a flower-pot saucer over a hot brick.(Collier, p.68)
While our understanding of the mechanisms of contagion and infection has thankfully developed since the 1800s and our delivery of medical treatment has vastly improved, it is shocking to realise that modern day anti-vaccination movements are just as they once were and that centuries of medical advancement has not yet inoculated the population against such doubts. To know that the following passages from The evidence at large, as laid before the Committee of the House of Commons, respecting Dr. Jenner’s discovery of vaccine inoculation, were published in 1805 and yet, aside from the flowery prose, could very well have been published today, is a frightening reminder that fighting the virus itself is only half the battle:
Notwithstanding therefore the cavils that have lately been renewed by certain ignorant or prejudiced individuals against the vaccine inoculation, I trust that the impartial and philanthropic will continue to feel an unshaken confidence in its merits ; that they will recollect the severe scrutiny it underwent, and the solemn sanction it received from the British Legislature ; which has since been confirmed by the unanimous testimony of the whole civilized world.(Jenner & Murray, p.xi)
A great many contagious fevers have afflicted humanity throughout history, but it is ignorance and misinformation that is the true plague. A lack of knowledge and understanding about the nature of a disease and the efficacy of its treatment can undermine the greatest attempts to keep it in check through quarantine, isolation, and inoculation. The hard evidence needed to combat anti-vaccination doubts has existed for centuries so why is it that history seems doomed to repeat itself?
Part of this family I had before vaccinated, and these, to the amount of four or five, performed the offices of nurses and attendants, and slept in the same room with the others labouring under the natural small-pox ; they were not however in any degree affected by the contagious effluvia; while every one of those who had not been vaccinated caught the small-pox; and one of them died. This circumstance, while it alarmed the rest of the villagers, gave them perfect confidence in the protective powers of the cow-pox, and they were now eager to be vaccinated. Accordingly, I procured some vaccine virus, and inoculated twenty more persons ; and as soon as I was satisfied of a sufficient supply of newly-formed matter, I appointed a day for a general inoculation. The language of persuasion was no longer necessary—the confident rustics quickly flocked around me, begging with the most earnest solicitation the protection of the cow-pox.(Jenner & Murray, p.vii-viii)
In our current situation, given what we know of Covid-19 and its subsequent mutations, it is vital that we remain vigilant and do not place undue expectations on the available vaccines. The World Health Organisation warned against complacency in December 2020 when it was clear that even with multiple effective vaccines, we still have a long way to go to stop the spread of the virus and repair the damage it has done to society. Thomas Southwood Smith asserts that while our actions can certainly lead to the spread of contagion, we thankfully also hold the power to halt its progression:
Epidemics are under our own control; we may promote their spread ; we may prevent it. We may secure ourselves from them. We have done so. We have banished the most formidable. Those that remain are not so difficult to be conquered as those that have been vanquished.(Smith, p.58)
We have banished formidable plagues and stopped the spread of fever and pestilence throughout history. This has been achieved time and time again through the concerted efforts of all medical staff, students and volunteers who sacrifice their own lives in the service of others.
These considerations should tend to relieve the public from unfounded apprehension of danger, and at the same time induce them to give their most zealous support to those excellent institutions, which are assiduously and effectually employed in mitigating a calamity so fatal to the lives and happiness of a large portion of the community…(Bateman, p.177)
I would like to acknowledge and thank all NHS staff in this country and all medical staff around the world for their unceasing efforts in the fight against coronavirus.
This post is dedicated to all those who have lost their lives to Covid-19 and to the loved ones they have left behind.
The common nature of epidemics, and their relation to climate and civilization. [electronic resource] : also, remarks on contagion and quarantine (1866) by Smith, T. Southwood (Thomas Southwood), 1788-1861; Baker, Thomas, 1819-; Murchison, Charles, 1830-1879 former owner; St. Thomas’s Hospital. Medical School Library former owner; King’s College London
The evidence at large, as laid before the Committee of the House of Commons, respecting Dr. Jenner’s discovery of vaccine inoculation [electronic resource] : together with the debate which followed ; and some observations on the contravening evidence, etc. (1805) by Jenner, George Charles, 1768-1846; Murray, John, 1778-1843, publisher; St. Thomas’s Hospital. Medical School Library former owner; King’s College London
The code of safety, or, Causes, effects, and aids, preventive and curative, as well of other epidemics, as also of Asiatic cholera. [electronic resource] (1849) by Collier, George Frederick, 1799-1877; Collier, George Frederick, 1799-1877 former owner; St. Thomas’s Hospital. Medical School Library former owner; King’s College London
A succinct account of the contagious fever of this country, exemplified in the epidemic now prevailing in London ; [electronic resource] : with the appropriate method of treatment as practised in the House of Recovery. To which are added observations on the nature and properties of contagion, tending to correct the popular notions on this subject, and pointing out the means of prevention (1818) by Bateman, Thomas, 1778-1821; St. Thomas’s Hospital. Medical School Library former owner; King’s College London