Quarantine may have taken the world by surprise, but it’s hardly a novelty for medical historians. Or perhaps this time there is just a little surprise, as the cruise ship dimension of the current crisis has recalled and repeated measures from an old maritime world more directly than, say, the SARS epidemic.

One of the more interesting elements of quarantine is that it is a largely unchanged practice; a response to communicable disease that is familiar and recognisable over centuries. This is highly unusual in medical and health history. Quarantine’s spatial logic is straightforward and easily understood, even if rationales for a segregative response have changed dramatically and are in fact hard to understand. Looking forward in time, we can speculate that physicians from seventeenth-century Ancona, eighteenth-century Marseilles, nineteenth-century Hong Kong and twentieth-century New York would all recognise, immediately, the current strategies put in place to contain the spread of coronavirus: the sequestration of ships, the containment of people on islands, the injunction to self-isolation in homes. Looking backward in time, people currently in quarantine as well as commentators on the virus, are regularly referring back to plague and Spanish Flu quarantines as part of well-known shared culture. There are very few medical practices that cast back and forward in time with such full and easy comprehensibility. Usually, in medical history, the past is a foreign country.

The problems produced by quarantine are also familiar across time; across otherwise almost unrecognizably different temporal worlds: the commercial implications of quarantine; the ships stranded in limbo, unable to pull in to ports; the travel bans; the concentration of risk in segregated spaces; the question of what to do with healthy carriers. All these have been raised again and again in past centuries as quotidian matters.

The typical response now is that quarantine is somehow bad, attached to premodern, illiberal governance. And certainly, quarantine is usually read as something that rarely worked and was ill-thought through. Quarantine is somehow wrong because we are made to do it. Even from conservative sources, critique of quarantine is the standard line: ‘[Quarantines] throughout history have been riddled with mishaps’, headlines Business Insider.’[1]

The main tradition of scholarship in the history of quarantine is one based on critique of state power. It became an object of inquiry for so many of us in the 1990s because it was a clear instance of states’ power to restrict movement of people and of vessels, or to disallow them entry into a territory or a port, or sometimes to enforce vaccinations. It went to the heart of evolving states’ capacity to compel behaviours of both citizens and aliens. How should states balance rights of individuals with risks to populations? How should risk be calculated, and rights infringed for greater benefits? And all along, how should and could quarantine be minimised – especially maritime quarantine – so as not to endanger commercial health, which relied on freedom of movement and goods?

This kind of exercise of power sat in contrast to then-highly favoured Foucauldian approach, and many of us used Foucault on ‘exile-enclosure’ to think through quarantine, and to consider a more complicated history than a mere ‘exile of the leper’. How might spatial confinement produce kinds of selves, even kinds of citizens? But the temporary nature of quarantine – unlike imprisonment – proved too short to say anything much. Actual ‘leper colonies’ became richer historical sites to explore the creation of subjectivities-in-isolation.

Quarantine also engaged many of us in the 1990s because it spoke historically to globalisation, and to freedom of movement and trade between, among and across nation-states, and also to the historical emergence of immigration regulations and restrictions. Quarantine was strongly linked to nineteenth- and twentieth-century race-based immigration laws, and my own contribution was to show not just a cultural but also a legal crossover between quarantine statutes and immigration statutes in any number of jurisdications, across the north and the south, the east and the west.[2] It was something brought home to me very sharply at a meeting in Hong Kong in the SARS moment, convened to think through the measures by which people’s movement could be legitimately controlled. Hong Kong lawyers cited clauses from various quarantine acts, and I recognised them immediately as drawn from (even the same as) clauses from Australia’s immigration restriction act – the legal basis of the old white Australia policy. Quarantine was and is about borders, from household to city borders to national borders. Immigration Restriction Acts in most, even all jurisdictions, always had disease clauses in them. Similarly, Quarantine Acts had clauses that empowered officers to deport or refuse entry.[3]

The analytic and political drive of most historical work on quarantine concerned race:  fairly straightforward, if important, analysis of the link between quarantine restrictions and race-based immigration restriction. Especially the long link between Chinese movement and disease anxieties has been traced and tracked extensively. It is absolutely the case that Chinese people outside China were sometimes, even often, quarantined not because they were infected, or in contact with infected cases, but because they were Chinese. This occurred regularly in the historical context I know best – the Australian context – in which anti-Chinese political cultures (White Australia) and mobilisation of disease threats were common and politically formative. All this is well established, and what seemed like great conceptual breakthrough in previous decades is now everyday understanding. It may be correct, but the race critique of quarantine measures is also quite predictable.

Even as I was writing that material in previous decades, the connections with race, racism and pathologizing of certain groups seemed obvious enough. More importantly, even then it seemed to sidestep a more difficult question. What do we do with epidemiologies (historic or current) that align with long-held racist presumptions, say about Chinese disease threats? We might be critical – as I have been along with many others – about immigration regulations that require additional screening measures from people from certain countries; for example, additional tuberculosis screening for people arriving from India, China, and Indonesia that is not required of people coming from the United States, the United Kingdom or Sweden. But what do we do if and when actual geographies of prevalence align that way? The three highest TB-burden countries are in fact India, China and Indonesia. Of course, there is a global political economy of disease burden that helps us understand why that might be the case, and should not be the case. That’s also both obvious and correct. But disease can’t be controlled in any urgent present by what ought to be. It must be managed by what is. Decades of critique of race and disease control measures still leaves that question and problem as unclear as it is uncomfortable.

Notes

[1] https://www.businessinsider.com/quarantine-history-following-china-wuhan-coronavirus-lockdowns-2020-1?r=US&IR=T

[2] Alison Bashford, ‘Immigration Restriction: Rethinking Period and Place from Settler Colonies to Postcolonial Nations’, Journal of Global History, 9, 1 (2014): 26–48.

[3] I. Convery, A. Bashford and . Welshman, ‘Where is the Border? Tuberculosis Screening in Australia and the UK 1950-2000’ in A. Bashford (ed.) Medicine at the Border: Disease, globalization and security, (Basingstoke: Palgrave), 97-115.

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Alison Bashford is Director of the New Earth Histories Program, UNSW-Sydney, previously Vere Harmsworth Professor of History at Cambridge University. She is editor of Quarantine: Local and Global Histories (2016) and author of Imperial Hygiene: A Critical History of Colonialism, Nationalism and Public Health (2nd edn 2014).