From Doom (Niall Ferguson, 2021) pp158-9
Perhaps not surprisingly, efforts at international cooperation had only limited success in the nineteenth century. The first International Sanitary Conference met in Paris in July 1851, but the representatives from twelve countries were unable to agree on standardized quarantine measures for dealing with cholera, yellow fever, and the plague. Divisions among the medical experts on the causes of cholera did not help, but the main bone of contention was between Great Britain, whose spokesmen regarded traditional quarantine measures as medieval obstacles to free trade, and the Mediterranean states—France, Spain, Italy, and Greece—which blamed the British for bringing cholera to Europe from their outsized Oriental empire.© The “English system” favored inspections of ships, isolation of sick passengers, and tracking of infected persons over blanket quarantines. This probably was superior, but it fell far short of what was needed to contend with the resurgence of bubonic plague. The International Sanitary Conference of 1897—held in Venice recommended that plague be controlled through isolation of the infected and incineration of their belongings. Unfortunately, the burning of property merely drove infected rats to seek new homes.
In Hind Swaraj (Indian Home Rule), published in 1908, Mahatma Gandhi called Western civilization “a disease” and referred scornfully to the West’s “army of doctors.” “Civilization is not an incurable disease,” Gandhi declared, “but it should never be forgotten that the English people are at present afflicted by it.” In an interview in London in 1931, he cited the “conquest of disease” as one of the purely “material” yardsticks by which Western civilization measured progress. Such complaints seem faintly ridiculous, until one considers how brutally colonial governments implemented public health measures. In Cape Town, during the third bubonic plague pandemic, black residents were summarily rounded up and removed from the waterfront to Uitvlugt (Ndabeni), which became the city’s first “natives location.” When bubonic plague struck Senegal, the French authorities were ruthless in their response. The homes of the infected were torched, residents were forcibly removed and quarantined under armed guard, and the dead were unceremoniously buried in creosote or lime. Small wonder the indigenous population felt themselves to be more victims than beneficiaries of public health policy. In Dakar there were mass protests and the first general strike in Senegal’s history.
In truth, the real advances of the nineteenth and early twentieth centuries were not scientific in the sense that many contemporaries imagined. For every advance by bacteriologists and virologists, there were erroneous steps in wrong directions, such as phrenology and eugenics. Progress took more humdrum forms. Public health benefited greatly from improved housing the shift in Europe from wooden walls and thatch to brick walls and tiles and regulations such as the UK Artisans’ and Labourers’ Dwellings Improvement Act of 1875. Mistaken ideas such as miasmatism could have positive results: the draining of swamps, bogs, moats, and other sites of standing water, the introduction of hydraulic devices to circulate water in canals and cisterns, the clearing of trash from residential areas, the ventilation of living quarters and meeting places, and the use of disinfectants and insecticides in homes, hospitals, prisons, meeting halls, and ships. Such measures—the right things done for the wrong reasons—significantly reduced the exposure of European and American populations to pathogens and their carriers,
John Snow is still a revered name in Soho because of his work in tracing the London cholera outbreak of 1854 back to a single water fountain on Broad Street that drew water from the sewage-filled Thames. But one did not need to accept Dr. Snow’s argument that human feces were the problem to see the benefits of water filtration systems and separate sewage piping. Likewise, the creation of a Metropolitan Board of Health for New York City in 1866 allowed an unprecedented response to yet another cholera outbreak: 160,000 tons of manure were cleared from vacant lots, the apartments of infected people were promptly disinfected with chloride of lime or coal tar, and their clothing, bedding, and utensils were burned.” According to one estimate, clean-water technologies such as filtration and chlorination were responsible for nearly half the total mortality reduction in American cities in the first four decades of the twentieth century, three quarters of the infant mortality reduction, and nearly two thirds of the child mortality reduction. Sanitation worked
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