Good health is the most basic condition for a person to live a thriving life and—as we have been witnessing for the last few weeks with the COVID-19 pandemic—countries desperately need their people to be healthy, too. Otherwise, society goes bonkers. Hence, the importance of public health measures to control and prevent the spread of disease.
Le bonheur, et souverain bien de la vie consiste plus en la bonne santé qu’en tous les biens du Monde, puis qu’elle l’entretien et prolonge, et que sans icelle elle est déplaisante. (Andre le Gros, 1625)
[Happiness, chief wellbeing of life, consists more in having good health than in having all goods of the world, since health maintains and prolongs life, and without health, life is unpleasant.]
Last week, Anni discussed public health measures imposed during times of pandemic, which—though necessary for the greater good—can have detrimental implications for people’s right to live free from interference from the state. She shrewdly compared a 1563 English Plague Order with current measures affecting us right now in 2020 because of COVID-19.
But in addition to imposing rules of quarantine, isolation, and other behaviors, early modern authorities, just like our authorities today, also tried to prevent the spread of disease via less draconian measures, especially by giving advice on how to contain the problem. I am curious to know how advice on prevention worked during the long winded Second Plague Pandemic compared to what we get today from our public health officials.
In a time before the germ theory of disease was accepted, some providers of health care believed that diseases could be passed on by bad, stinky air, which they called miasma. This idea, which already existed in Hippocrates’ time, was expanded and popularized by Galen, and it was also what many health practitioners believed in the early modern period. In the absence of a visible cause for the disease, the idea that miasma was what caused it made a lot of sense: proximity to those infected with the plague led healthy people to become sick, so the bad air in the vicinity of sick bodies was the primary suspect, especially given the stench that inevitably hang around places where the disease struck. Notice below in Nicolas Poissin’s painting The Plague of Ashdod how a character on the right side covers his nose.
La Peste d’Asdod by Nicolas Poussin (1630) Source: Wikimedia Commons
éviter le mauvais air, et principalement celui qui est gâté et infecté de ceste maladie, et ou elle est, et a été ; se retirer des grandes assemblées et compagnies suspectes, se contenir chez soi si on n’est pressé d’affaires ; se tenir nettement, faire bon feu dans le logis, et aux rues aussi, qu’on doit bien nettoyer et en ôter les immondices, et y jeter souvent de l’eau fraiche et nette; parfumer les maisons et chambres avec bois, herbes et drogues de bonne senteur.
[avoid bad air, especially air that is spoiled and infected with this disease, and [places] where it is and has been; withdraw from large assemblies and suspicious companies; contain oneself at home if one is in no hurry due to business; keep oneself clean, make a good fire in the house and in the streets, too, which must be cleaned well and be rid of trash, and [where] fresh and clean water should be thrown often; perfume the houses and rooms with wood, herbs, and drugs that smell good.]
Today we know that stinky air, though unpleasant, is not the cause of the plague. Bacteria named Yersinia pestis cause the disease. And the germ theory is now so well established that in popular parlance about our current evildoer—the coronavirus—we give priority to mentioning the microorganism. We are capable of imagining these tiny invaders entering our respiratory system to wreck havoc. Invisible little bodies populating the surface of our skin must be flushed with soap and water, or killed with alcohol-based hand sanitizer.
WHO advice for the public to prevent Coronavirus disease (COVID-19)
_______________________________________________
Update: A previous version of this post stated that the miasma theory came from Galen, but he in fact expanded upon earlier ideas, including those of Hippocrates. Thanks to Natacha for the correction.
“Germ Theory of Disease.” In Wikipedia, March 20, 2020. https://en.wikipedia.org/w/index.php?title=Germ_theory_of_disease&oldid=946550640
Jones, Colin. “Plague and Its Metaphors in Early Modern France.” Representations 53 (1996)
Kannadan, Ajesh. “History of the Miasma Theory of Disease.” ESSAI 16, no. 1 (April 1, 2018). https://dc.cod.edu/essai/vol16/iss1/18
Le Gros, André. Régime de Santé, Souverain Bien de l’homme En Ceste Vie, Observant Les Préceptes de Hyppoc. et Gal., Avec La Manière de Se Préserver Contre La Peste . Ensemble La Protestation d’Hyppoc., Mise En Vers François Par Un Ancien Médecin de La Faculté de Paris. Dédié à MM. de Paris, Par Un Docteur de La Mesme Faculté, 1625. https://gallica.bnf.fr/ark:/12148/bpt6k5629510w
“Second Plague Pandemic.” In Wikipedia, March 22, 2020. https://en.wikipedia.org/w/index.php?title=Second_plague_pandemic&oldid=946815591
A month ago, I started seeing one of my old sources, a 1563 Plague Order for the City of Westminster, in a new light.
“Maybe this could be of current interest”, I thought, and stored it in a drawer for later thought. As the weeks passed, I pulled the Order out my drawer more and more often. Then, a week ago, I realised with a mix of intrigue and disbelief that the draconic measures of the Elizabethan Plague Order were not just the emergency measures of the early modern state, they were the measures of the modern state. In the week that has passed, the similarities have only become more pronounced. From my home desk, history has seemed to warp and repeat itself. In all this, one thing seems certain: measures for fighting against epidemics have not in their essence changed since the 16th century, but surely, notions of privacy have.
The otherwise little used word “Quarantine”, originally a forty-day period of isolation, has rapidly moved from passive periphery to active centre stage in our daily vocabulary.
Across the globe, the spread of the Corona Virus is intensifying by the day. And country after country joins the ranks of those with citizens that are affected by the contagious disease. Throughout these countries, the dual-method for dealing with the threat of mass contagion is simple: quarantine and a tracking down of every person with whom the sick citizen has had contact. These precautions, the isolation of an individual, either in the individual’s home, or as we have seen, in hotel resorts, hospitals or even a cruise liner, and the searching out of the person’s movements, activities, and daily interactions, are, from society’s point of view, necessary for the common good. But to the individual citizen, they are also direct, physiognomic, spatial, and informational invasions on the individual’s personal privacy.
As such, the legal and health regulatory developments that are presently being instated across the world beg the question: is health a public or a private issue?
According to a recent tweet by the influential eco journalist, Adam Ramsay, the case is clear: “health isn’t private”. [1]
Instead, Ramsay explains, “Everyone’s health relies to some extent on everyone else’s. Healthcare has to be public because health is public.”
Broadly speaking, we might identify this form of logic as a “common good” sort of argument that reminds us of the prevalence that the benefit of the many takes over the benefit of the few.
At the Centre for Privacy Studies we investigate notions of privacy in early modern Europe in the period between 1500-1800. Needless to say, the question of how to contain and abate mass epidemics was an issue of concern in this period also. My own focus at the Centre is on the City of Westminster during the rule of Elizabeth I (1558-1603), whose reign saw several visitations of the plague.
You might ask what the plague in the 16th century has to do with a virus epidemic in 2020. Well, for one, they have the quarantine in common. Second, they share a similar rhetorical focus on “the common good” as well as a complementing vilification of private interest. Finally, they share a fundamental shift in the balance of power between individual and state. A shift that is perhaps best understood as an invasion or annexation of territory that the state had more or less formally relinquished to the private citizen, but in cases of emergency reclaim to their absolute domain. It is difficult to talk about rights and privacy in 16th century England, but we might, by negative inference, be able to detect the thresholds that the state saw fit to regulate and invade in emergencies. Thresholds that it might not otherwise have bothered with.
The 1563 Plague Order for City of Westminster:
[2]”Fyrst we wyll and command you in the name of our sayde soueraigne Ladye … to … shutte up both … doors and wyndowes towards the streates or common ways by the space of fortie dayes.”
This command is from the Plague Order, issued in March 1563 by the Secretary of State, William Cecil. It commands the civic officials of Westminster to shut up any houses with infected members, placing the sick and their households in quarantine.
In the Order, clear rules for disregarding the quarantine are delineated. That is, should a member of the household be let out – or should a visitor or customer be let in – that same person would be “committed to the upstockes” for about seven days and then brought to the “common gayle” to remain there for a full forty-day quarantine.
[3] Picture from Siobahn O’shea’s blogpost “How bad were the medieval stocks?”The measures, quarantine in the case of sickness and corporal punishment in the case of disregarding the quarantine, might seem draconic to modern ears. Yet, in China and Italy, two of the most severely infected countries to take measures against the present Covid-19 epidemic, corrective regulations have been passed to discipline those that trespass against their quarantine – or even misinform the health authorities about their activities. The need to assess whom an infected individual might have infected unawares is an important part of containing the spread of the virus, but it is also information that is fraught with details about our private lives. Details we might not want to share either with the authorities or even with family members. There is no evidence in the 1563 source that any such care towards detecting potentially infected individuals took place.
In 1563, quarantine measures were still relatively new in England.[4] And, as we have seen ample evidence of in the past months of Covid-19 coverage, quarantine is still very much in use. Some things however, have changed since 1563.
As stated, quarantine was still a new measure in 1563 and with new visitations, new means were developed to perfect quarantine measure. One of the improvements was the building of pesthouses, or of pest fields, as in the case of the parish of St. Martin’s in the Field. Pesthouses were places to which sick members of a household could be sent for the remaining duration of their life, or in some happy cases, the duration of the quarantine. The infected households in question would still be shut up, but with a significantly smaller risk of catching the disease themselves. Before the pesthouses were used, households would simply be shut up with all of the inhabitants inside, sick or not.
So, in a household of, say, seven, even if only one person were ill, the entire household would be put under quarantine until the house was opened again forty days later. How many, we might wonder, would survive such conditions?
The local parishes of Westminster were at the core of organising everything from shutting up houses, taking away the dead, detecting the infected, collecting money for charity, and doling out “victuell and fuell” to the “persons shutte up and forbidden to come abrode.”[5] The number of deaths during the 1563 plague are fraught with uncertainty, but based on the parish registers of Westminster and London, scholarship on the period estimate a 1000 deaths per week for several months.[6] According to John Charles Cox’s The Parish Registers of England, the parish of St. Martin in Field noted a total of 177 burials in 1563, “145 of which are followed by the word peste.”[7] This might not seem like a daunting number but according to the parish registers, yearly burials would be in the tens and twenties, not in the hundreds. This is evident in Cox’s table over burials between 1562 and 1564 in five nearby London parishes.
[8] John Charles Cox, The Parish Registers of England, p. 145.To some extent, the 1563 Plague Order informs us of how the state reacted in the face of emergency – quarantine measures, punitive regulation and organisation of poor relief for the quarantined, but it doesn’t tell us anything about how the people reacted. Did they keep the quarantine? And if not, how were such trespassing detected and monitored?
Looking into praxis – Newman’s work on the 1636/37 bubonic plague:
The early modernist, Kira L. S. Newman, seeks to answer some of these questions in her excellent research on the bubonic plague in 1636-1637 London and Westminster.
The question of whether or not quarantined citizens respected their quarantine is answered with a resounding “no” in Newman’s sources. Watchmen were posted outside houses and on corners to keep an eye on the infected households and make sure that none left or entered. In fact, Newman’s sources show a whole list of necessary occupations taken on by the local parishes. The sources from the parish of St. Martin in the Field are particularly detailed and describe the expenses towards a whole corpus of personnel: “nurses, watchmen, bearers and searchers.”[9]
Perhaps unsurprisingly, Newman’s investigations show that it was not the poor, nor the wealthy, that broke their quarantine, or tried to bribe the searchers not to report on an infected member of the house – or bribe the watchmen to look the other way when customers and visitors came calling. No, it was the industrious middleclass. The tailors, the shoemakers, the shop keepers, the innkeepers and other forms of small business owners whose livelihood were pulled from down under them with the severe restrictions on mobility and heavy death tolls in their clientele.
Newman writes that “There was a conspicuous absence of the poorest from the Session Rolls.”[10] The poor, she argues, would be given food and fuel free of charge and therefore might have had less incentive to disregard quarantine orders. But not all poor people had a home or space to share that was theirs. What did the poor people that rented rooms do? The answer to this question is vividly given in the 1563 plague order: they were not shut up. They were shipped out.
Rhetoric and vilification:
“And further, where it is evidently knowen that in the sayde Citie of Westminster, there be greater numbers of people inhabytyng, and as it were swarmyng in every rome, than can reasonably have their sustentation by their honest labours or trade of lyvyng, by reason that for gredinesse and lucre many owners or tenauntes of houses, do take into them other inhabitants and famylyes, to dwell in some part of theyr chambers, shoppes, cellers, or leanetoos, paying for the same also such excessyue weekly, or other kynde of rentes, as they can not mayntayne them selves in sekyng the same by sundry kyndes pf disorder”.[11]
This section of the order is so strikingly rich in its portrayal of the social situation in Westminster. Its portrayal of private property and private greed vs. public good reveals a system that did not have the state apparatus to deal with overpopulation, nor, significantly, the means to contain the spread of the infection. The reasons for Westminster’s overpopulation are compound. For one, Westminster was the seat of power. When Westminster was not visited by the plague, parliament, the royal court and the legal courts were open for courtiers and those with political and legal affairs from all of the country. The wealthier of these would have houses in Westminster for this specific purpose. Similarly, the well-connected would stay with wealthy friends. Everyone else would have to rent houses, rooms, or beds according to their means and status. In turn, such activity brought in servants or demanded that temporary servants be taken on for the duration of a stay, meaning that those in need of a job, or wanting to sell their goods at the market would flock to Westminster too.
Unlike the lockdowns of France, Spain and Italy, the City of Westminster was not shut up nor locked down. Much like Boccacio’s group of imaginative noblemen and women in The Decameron, the rich fled to their country houses and the poor remained.
All those that in the state’s eyes were “swarmyng in every rome” were sent back to where they came from. And those that defied these orders, perhaps in an attempt to make some extra money by continuing to lend out their “shoppes, chambers, cellars or leanetoes” were publicly shamed for their private interest – their “greedinesse and lucre”. Additionally, those that did rent a place, be it in a shop or chamber – were deeply vilified in the Lord Secretary’s description. It is unthinkable by the logic laid out in the Order, that such persons would be able to sustain themselves by an honourable profession. The Order’s careful wording evoke powerful images of greedy self-interest and dehumanised hordes of criminals, endangering the health of the city. The connection that Lord Burghley forges between greed and private interest is by no means novel. In the Acts of Parliament, we see an even more directly expressed vilification of private interest as “private greed”, “lucre”, “profit” and “gayne”. The table below gives an overview of non-formulaic priv*-words, in the Acts of Parliament from 1547 to 1603.[12]
The diagram shows the number of occurrences of priv*-words (words that have their root in the Latin privatus) across the reigns of Edward VI (1547-1553), Mary Tudor (1553-1558), and Elizabeth I (1558-1603).
Vagrants, day-labourers, season workers and their families were, according to the Plague Order, thrown out of their homes, be they rented or lent. Those with permanent settlement in Westminster on the other hand were, if suspected of being infected, shut up in their home, or in the case of servants, in the home of their master. In the first case, such action robbed citizens of the roof over their heads. In the latter case, it robbed citizens of their personal mobility.
The Plague Order from 1563 is unambiguous and unapologetic in its intrusion into private property. The privacy to do what you want – with and in – your property or lodging is unflinchingly interfered by the authorities when the state is in a state of emergency.
Health Status – to be or not to be publicly marked?
With 21st century eyes, these actions are very serious potential violations to personal freedom and privacy. But that does not mean that 21st century governments have not enforced similar measures in states of emergency. In Denmark, we have all been encouraged to work from home and stay indoors and in this moment of writing, all shops, cafés, bars and restaurants are being shut down.
An Emergency Act was passed this week in the Danish Parliament. The Act was passed with a unanimous vote across the political parties. One thing, however, was fiercely debated before the Act was put through; namely, the inviolability of private property. In the Act, the government wants to have the possibility to grant officials the right to search and enter private property without a search warrant. The permission has not been put into use, but it is now in the government’s arsenal, should circumstances call for such drastic measures.
Turning to another example of state muscle-flexing, the French prime minister, Emmanuel Macron, has declared war on the virus and placed the entire country under a 14-day lockdown. During this lockdown, non-essential excursions will be fined.
In the province of Hangzhou, as reported early this month in the New York Times, a new system of classification is introduced to control citizen’s movement and determine their virus status and thereby assess their right to mobility. [13] The app, Alipay, is used to give citizens a health code: Green is good and gives free access to public space and transport, yellow means seven days’ isolation and red results in a 14-day quarantine. The status of your health is based on your movements and the people you have been in contact with. All trackable through the app. As with so many of the measures now put in place, we find historical equivalents. None are found in the 1563 Plague Order, but the Plague Order from 1578, not directed at plague in Westminster but in the countryside, gives an Elizabethan example of publicly marking health status. In the order, it is explained that those quarantined at their farms are allowed to care for their livestock and manure their fields. But it is also noted that such persons “be neverthelesse retrained from resorting into companie of others either publicaly or privately during the said time of the restraint, and to wear some marke in their uppermost garments, or beare white rods in their hands at such time as they shall goe abrode”.[14]
In the case of the app Alipay, used in China, the concerns in terms of privacy and mobility tracking are of course significantly more far-reaching. Emergency Acts are rushed through parliament in countries across the world and as much as such emergency legislation is for the benefit of the common good, citizens also voice valid concerns.
Privacy in a State of Emergency
In a recent article in the L.A. Times, the newspaper answered a question about governmental infringement on the private sphere: “What can the government force people to do in the name of containing the coronavirus?”[15] We might notice the overt hostility and scepticism in verbal phrasing of the question. The word “force” springs to our attention, but also the formulation “in the name of” indicates a deep mistrust towards state interference. What this question brings to mind is the monopoly on legitimate violence vested in the state. The monopoly on legitimate violence is one of the defining aspects of Max Weber’s understanding of statehood. The 1563 Plague Order and the rampant Covid-19 crisis reminds us that this monopoly is constantly negotiated across the different zones of society as perception of what pertains to the public domain expands and contracts. In France, parliament started out by advising its citizens to stay indoors and avoid social engagements and physical contact. Because the initial advisory precautions have been disregarded, the state has now enforced a strict curfew that the law enforcement is tasked with controlling the adherence to. And even more dramatically, the Spanish government has now called in the military to patrol the streets and ensure compliance to the official regulations on personal mobility. [16]
What we might conclude from looking at epidemic induced states of emergency from 16th century England to the present day globalized world is that in cases of emergency the public sphere becomes more elastic as it expands to regulate more and more aspects of society. At the Centre for Privacy Studies we are particularly interested in notions of privacy in the overlaps and thresholds between different societal zones. A visualization of these societal zones in a non-emergency state could look something like this:
But as the headline of the L.A. Times article manifests, the proportional interrelation between the zones undergoes a significant, if not dramatic, shift in cases of emergency:
Naturally, the measures against epidemics have changed, but quarantine and disciplinary actions towards those who disregard the quarantine remain core measures, and have been so for over five hundred years.
During this period, our notion of privacy in northern Europe has changed dramatically, especially in the past two hundred years. And worries about what the state might force you to do are expressions of this. But predominantly, citizens seem to agree with Adam Ramsay: Health is a public issue. Such status legitimises the expansion of the public sphere in cases of health emergency today and historically. The question then is whether our more developed and legally manifested notions of privacy even matter in emergency situations. When it comes to state nullification of private spheres, be they personal, informational or spatial, has the situation over the past five hundred years merely changed from ignorance to informed consent?
Leaving that polemical question to linger, I will thank you for your attention. Please comment and please share any sources you might be working on that, like the 1563 Plague Order, gives you that crazy sense of being in a warped space-time continuum.
Sources Cited:
[1] @AdamRamsay (Adam Ramsay), “The Coronavirus is an important reminder that health isn’t private. As a species we live in herds. Everyone’s health relies to some extent on everyone else’s. Healthcare has to be public because health is public.“, Twitter, 28 Feb. 2020, twitter.com/AdamRamsay/status/1233341409815646209
[2] Wyllyam Cecill Knight, High Stewarde of the Citie of Westminster, and Ambrose Caue, Knight, Chauncelour of the Duchye of Lancaster, Two of the Priuie Counsell to the Quenes Moste Excellent Maiestie, to the Baylyffe, Headboroughs, Constables, and Other Officers within the Sayde Citie … Greeting Knowe Ye That Our Sayde Soueraigne Lady the Quene, Hauyng Compassion of the Estate of That Her Citie, Because of the Long Visitation Thereof with the Plague …, Early English Books, 1475-1640 / 1881:05 ([S.l.] : Jmprinted by Richard Jugge, Printer to the Quenes Maiestie, Cum priuilegio Regiae Maiestatis, [1563], 1563).
[3] Siobhan O’Shea, ‘How Bad Were the Medieval Stocks?’, Interesly, 2018 <https://www.interesly.com/how-bad-were-the-medieval-stocks/> [accessed 6 March 2020].
[4] Kira L. S. Newman, ‘Shutt up: Bubonic Plague and Quarantine in Early Modern England’, Journal of Social History of Crime, Corruption, and States (Spring 2012, pp. 809-834), p. 809.
[5] Wyllyam Cecill Knight, 1563.
[6] J. Charles Cox, The Parish Registers of England (London Methuen, 1910), p. 144 <http://archive.org/detail/parishregisterso00coxjuoft> [accessed 16 March 2020].
[7] Cox, 1910, p.145.
[8] ibid.
[9] Newman, 2012, p.811
[10] ibid. p. 823
[11] Wyllyam Cecill Knight, 1563.
[12] The data is mined from The Statutes of the Realm: Printed by Command of His Majesty King George the Third, in Pursuance of an Address of the House of Commons of Great Britain. From Original Records and Authentic Manuscripts, 10 vols (Dawsons of Pall Mall, 1810), iv, part I <http://hdl.handle.net/2027/pst.000017915502> [accessed 30 October 2019].
[13] Paul Mozur, Raymond Zhong, and Aaron Krolik, ‘In Coronavirus Fight, China Gives Citizens a Color Code, With Red Flags’, The New York Times, 1 March 2020, section Business <https://www.nytimes.com/2020/03/01/business/china-coronavirus-surveillance.html> [accessed 17 March 2020].
[14] Wyllyam Cecill Knight, 1563.
[15] ‘Q&A: What Can the Government Force People to Do in the Name of Containing the Coronavirus?’, Los Angeles Times, 2020 <https://www.latimes.com/science/story/2020-03-02/coronavirus-government-restrictions-legality> [accessed 3 March 2020].
[16] ‘Coronavirus Spain: Government Sends in the MILITARY to Police the Streets amid Lockdown | World | News | Express.Co.Uk’ <https://www.express.co.uk/news/world/1255657/coronavirus-spain-lockdown-military-patrol-streets-madrid-valencia-santa-cruz-tenerife> [accessed 19 March 2020].
