Shutting Up Infected Houses: Infectious Disease Control, Past and Present

At the time of writing this article (March 2010), the world remains in the highest phase of pandemic alert. Fortunately, it looks as though the influenza A H1N1 pandemic has been relatively mild. Except for certain risk groups (e.g., those with pre-existing morbidity, pregnant women, marginalised communities), this pandemic has not had the devastating impact on public health and societal life that many feared. However, despite the feeling of having had a lucky escape this time, the general view amongst public health professionals, planners and scientists is that it is just a matter of time before we are hit by a much more deadly influenza pandemic. Part of this ongoing concern is based upon historical accounts of past influenza outbreaks, most notably the 1918 Spanish Flu (Crosby, 1989). Historical studies are not only illuminating in the sense that they result in better understanding of the epidemiology of past epidemics, but they also offer vivid lessons as to how infectious diseases may impact upon all aspects of the lives of individuals and communities. One of the salient features of infectious diseases is that they may result in certain aspects of our everyday social lives becoming the source of an increased threat of harm: talking to one’s neighbours, going to work or to school, children playing together, congregating in public places to protest or enjoying music or sporting events. All such routine activities become the focus of concerns about potential modes of disease transmission, and in the face of dramatic risks this is likely to affect everyone’s attitudes to strangers, friends and to themselves. One outstanding work in the social history of epidemics is Moote and Moote’s (2004) The Great Plague: The Story of London’s Most Deadly Year. The 1665 plague killed, by rough estimation, one fifth of all inhabitants in London. Moote and Moote explore how Londoners coped with the threatened and the actual ravages of the disease. Their book is based upon numerous personal and official documents, such as the diaries of Samuel Pepys (Pepys and Braybrooke, 1887), letters of inhabitants and the registries of London parishes. It tells stories of people fleeing to the countryside, of uncertainty and panic amongst those staying in the city, of the rumours about possible cures and wonder drugs and the competition and struggles between Galenic and ‘chemical’ physicians and apothecaries peddling their potions and ‘cures’. Quarantine measures such as those governing travellers arriving on ships from certain European harbours were in place, but it seems as though they could be easily bypassed. One of the measures used, particularly in the early stages of the plague’s arrival in London, was the traditional method of social distancing used in previous plagues in London. Persons showing symptoms were locked up with their families in their own houses, as a means of both isolating those infected and quarantining those presumed to have been exposed to infection. Such houses were then in turn supported by local church parishes: given the role of supplying food, guarding the properties and employing nurses to care for the families that were locked up. During the outbreak of 1665, an anonymous author wrote a pamphlet about the policy of ‘shutting up’ infected houses. This paper, printed and published during the plague, can be considered not only as a contribution to the contemporary debates about the legitimacy of such measures, but also to public health ethics avant la lettre. We are pleased to republish it here in the first issue of 2010, which is almost entirely devoted to discussion of ethical issues relating to infectious disease control. The author of the pamphlet argues passionately against the shutting up of people within their houses. The arguments are clearly based upon first-hand experience and the introduction to the pamphlet even suggests that the author was struck by illness during this time. In the seventeenth century, the pamphlet was a vitally important means of debate and discussion of topical, political and religious issues. Here, the author uses rhetorical devices, religious and political arguments, historical and statistical evidence, and medical knowledge to try and press for the primary end of writing: as a means of changing policy. However, in retrospect it is interesting to see that the seven arguments that are advanced against compulsory isolation are, mostly, as relevant today as they

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