Quarantine Life from Cholera to COVID-19

What Pandemics Teach Us About Parenting, Work, Life, and Communities from the 1700s to Today

Kari Nixon

• Publisher: S&S/Simon Element
• Year: 2021
• ISBN:
  9781982172473
• Topic: Social Sciences
• Subtopic: Global Development Studies
• Index: Social Sciences

For readers of Mary Roach and Jared Diamond, an innovative look at the histories of different epidemics and what it meant for society, alongside what lessons different diseases have to teach us as society battles the novel coronavirus. Throughout history, there have been numerous epidemics that have threatened mankind with destruction. Diseases have the ability to highlight our shared concerns across the ages, affecting every social divide from national boundaries, economic categories, racial divisions, and beyond. Whether looking at smallpox, HIV, Ebola, or COVID-19 outbreaks, we see the same conversations arising as society struggles with the all-encompassing question: What do we do now?In "poignant yet relevant detail" (Niki Kapsambelis, author of The Inheritance ), Quarantine Life from Cholera to COVID-19 demonstrates that these conversations have always involved the same questions of individual liberties versus the common good, debates about rushing new and untested treatments, considerations of whether quarantines are effective to begin with, what to do about healthy carriers, and how to keep trade circulating when society shuts down.This vibrant social and medical history tracks different diseases and outlines their trajectory, what they meant for society, and societal questions each disease brought up, along with practical takeaways we can apply to current and future pandemics—so we can all be better prepared for whatever life throws our way.

1 #LISTENTOWOMEN

Smallpox, Vaccines, and the World before Germs

1721

A walnut shell full of infected pus and women’s intuition changed the world as we know it. In 1721, when Mary Wortley Montagu, an English ambassador’s wife on a voyage to Turkey, saw Greek women saving their families from smallpox by having infected pus purposefully put into open wounds on their children’s arms, she saw her chance to change the world—and she refused to let men ignore her. Her story, and several others like it, presents concise lessons that the history of vaccination can teach us in the time of COVID-19—messages that actually have nothing to do with vaccination itself, and everything to do with

• Lesson 1: Looking for answers where you least expect them (aka Listen. To. Women.).
• Lesson 2: Understanding that public health debates have always been about a tension between individual liberties and the collective good.
• Lesson 3: Realizing that “choice” is a relative concept.

Montagu’s story—and those of other women trying to protect their children from disease—is a helpful beginning point as we attempt to navigate plague survival, not only because she precedes other stories in this book chronologically but also for another important reason. Her experiences show us that before we can dive into the difficult work of survival and rebuilding, we first need to be sure that we’re asking the right questions and looking for answers in the right places. The lessons derived from Montagu, in other words, help us calibrate our initial approaches to tough questions and even tougher conversations. But before we begin her story of courageous motherhood, I want to share another, more recent one that may seem unrelated but has helped me understand critical aspects of Montagu’s own story from a very different vantage point.

Dublin

March 26, 1842

Ms. McCormick looked sleepily out the window, attempting to gauge, by the amount of light, what time it was. She squinted at the darkness; it was the middle of the night—maybe 2 a.m., if she had to hazard a guess. She could hear little Patrick wheezing in the bed next to her, and her heart hitched midbeat in her chest, hovering between instinctive parental panic—Is he sick again?—and seasoned maternal confidence—a little raspy breathing was nothing; he had just been treated in hospital for a suspicious cough, after all. He was probably still on the mend. Should she rouse him? She sat up, put her feet on the floor, and paused, wavering between these poles of certainty and fear while also weighing her divided physical loyalties—her own twelve months of sleep deprivation since Patrick’s birth and her impulse to check on her baby.

Ultimately, the special cocktail of guilt and duty surging through her in the black darkness won out, and she lifted her baby from where he had been nestled. As her drowsiness melted away, she could now hear just how labored his breathing sounded. His back vibrated jerkily in her palms with every laborious drag of breath. What had begun as dutiful, better-safe-than-sorry wakefulness now crystallized into sheer panic as her eyes adjusted to the darkness and she could see him. As he strove to breathe, Patrick worked his tongue in and out of his mouth with a furious intensity that bespoke fever and delirium—that much was obvious even in a child this young. She’d never seen any baby do this—rolling the tongue up and down along the hard palate, in and out along the teeth, as if the organ were irritated. She’d never, in fact, until that moment considered the tongue to be an organ unto itself, and before she could fully piece together the raw ends of her alarm, she saw her baby boy as he was—a mere sack of organs, vulnerable to some horrible fever that was eating away at him before her very eyes. She put Patrick to her breast, relieved that he nursed readily. That had to be a good sign, she told herself, as she sent for the doctor and the apothecary.

The apothecary arrived first, but Ms. McCormick was glad to see anyone who could offer help. Although she was anxious for the doctor to show up, Mr. Brown was gentle, putting Patrick into a warm bath to soothe him, and administering emetics. When the doctor finally came, along with a colleague, Ms. McCormick was grateful to see them try everything medical science could recommend. She was a poor woman, and she hadn’t been sure anyone would help her. The doctor disagreed with the emetics. Instead, he injected the baby with turpentine. By 11 a.m., Ms. McCormick was both comforted and despairing at the doctor’s continued presence. She was grateful he was there, of course, tending to her poor baby, but the fact that he had remained so many hours meant this was serious. He wouldn’t have stayed if he’d been woken at this time of morning for nothing. She looked out the window, hoping for a momentary distraction, watching the town go about its midday business while the atmosphere inside her walls was a nauseating mixture of monotony tinged with crisis; no one had moved, changed clothes, or taken a break for almost nine hours now, but everything had changed—everyone knew she might lose her baby. It was the secret no one whispered but everyone harbored. She glanced over her shoulder at the doctors. No one noticed her. How horrific to imagine that she, Patrick’s own mother, was useless to him now! She who had given him life could only stand at the edges of the room wondering if he would die. The doctors were drawing blood from his arm while administering a mix of mercury and something else she couldn’t recognize. Two hours later, there was still the sickening same-not-sameness as they bled her son’s tiny body. (Bleeding was not much en vogue anymore, and perhaps it’s for the best that Ms. McCormick likely didn’t know that this probably meant the doctors were running out of ideas.) By evening, she had her boy back with her, nursing readily. That has to be a good sign, right? her inner voice repeated—this time, however, with a question mark added and an undertone of urgency, of desperation.

Dr. James Duncan, the man who eventually recorded this case, had arrived just after daybreak on March 26, and his case notes reveal the extent to which pre-twentieth-century society was collectively at the mercy of disease. Treatment after treatment was delivered to poor Patrick—everything as touchingly soothing as nursing with his mother and a warm bath to procedures that make the modern reader cringe (turpentine and mercury pumped into him, bleeding and laxatives draining his strength). These exhaustive efforts illustrate the very real desperation of doctors and families in this period to save their loved ones. Duncan’s notes, published in his book Illustrations of Infantile Pathology: Measles, describe little Patrick McCormick as a “fine stout infant,” and his nearly hourly journal of Patrick’s progress, though largely optimistic in tone, ends abruptly with the baby’s death during a series of violent seizures.¹

Even 134 years later, one can visualize the “fine stout infant” readily. Duncan’s copious notes make it inevitable that readers find themselves attached to the little boy, rooting for him and his mother, who, while standing across the bounds of two centuries from us, were nevertheless very real people who suffered greatly. While reading this for the first time, the mother in me stopped short when I came to the line announcing no further updates on little Patrick. I had assumed—as it seemed his own mother, the doctor, and the nurses also did—that he was making great progress. My heart caught in my throat when I read that he’d died after twenty-four hours’ struggle with post-measles complications. I first read this mother’s story while living in Washington State, an anti-vaccination stronghold, during a period when measles cases were on the rise. Her story reminded me of another mother who was born more than 160 years before her: Lady Mary Wortley Montagu. The two were separated by huge disparities in wealth and more than a century in time, but reading Ms. McCormick’s experience allowed me to reflect on Montagu’s in the shared light of their motherhood, and in the shared context of mothers’ unique trauma in eras of high infant mortality. Though there were certain diseases associated with overcrowding that were less likely to affect the rich, in general, wealth made no great difference in terms of disease survival at a time when society had no real treatments for these ailments. What I’m about to tell you is the story of when Lady Montagu chose to do something very brave, but Ms. McCormick’s story prompted me to ask: Did Montagu really choose to, or did she have to, to protect her children? And if her different experiences as a mother affected her perspective about the options available to her, did it also impact where she sought answers?

London

April 1721

I envision Lady Montagu on her life-changing day in 1721, standing with the sort of feigned steadfastness that I can recall mustering when breastfeeding my daughters in public. I imagine her standing stiffly, with a kind of “fake it or you’ll never make it and be taken seriously” hitch in her shoulders, mixed with a “come and fight me” set to her lip that I remember summoning up myself, in lieu of real bravery. The London air would have been just losing the last whisper of chilliness. Spring was steadily blooming as Lady Montagu stood alongside her daughter, waiting to begin. Among other witnesses there that day were four medical professionals. One, the surgeon Charles Maitland, would perform the procedure; the other doctors were brought from the College of Physicians as witnesses so that they could spread news of its success or failure. Lady Montagu was hardly the star of the hour—she was not at all what people had come to see—but my mother’s heart zeroes in on her tension, her intense focus on trying to believe she was doing the right thing. Her pulse must have raced even as she kept that stiff upper lip—what if she was killing her daughter?

It was too late for fear now, however, as Charles Maitland approached three-year-old Mary (folks at this time weren’t very creative in their naming practices) with a pus-laden lancet, made an incision on her arm, and spread the organic slime into it—slime that would have been harvested from an actively infected smallpox patient. No turning back now.

This day had been a long time in the making. Lady Montagu had recently returned from her travels abroad to Turkey (then known as the Ottoman Empire) with her husband, a British ambassador. While there, she observed that smallpox, a disease that intermittently devastated communities back home, seemed to be much less of a problem in these areas, places the British ironically viewed as “primitive” and “backward” (the British generally saw anyone who wasn’t British in these terms, and they did even more so with regard to countries outside of Western Europe).² She inquired of local women in Turkey about this and was told about a strange process of preventive care, which she later witnessed. Her own experience with smallpox in 1715, which left her scarred, also likely made her keenly interested in investigating preventive measures. She explained the process she’d observed in Turkey in a letter home to her sister:

The small-pox, so fatal, and so general amongst us, is here entirely harmless by the invention of ingrafting, which is the term they give it. There is a set of old women who make it their business to perform the operation every autumn, in the month of September, when the great heat is abated.

… The old woman comes with a nut-shell full of the matter of the best sort of small-pox, and asks what vein you please to have opened. She immediately rips open that you offer to her with a large needle (which gives you no more pain than a common scratch), and puts into the vein as much matter as can lye upon the head of her needle, and after that binds up the little wound with a hollow bit of shell.³

If you think the “vaccine wars” are intense now, characterized as they are primarily by groups of affluent white mothers who fear toxic chemicals, then buckle up. In her book Alchemy and Empire: Abject Materials and the Technologies of Colonialism, Rajani Sudan, a scholar of early modern British literature (and my mentor), explains that because Lady Montagu returned home from a nation the British saw to be beneath them, touting a foreign medical procedure—one traditionally presided over by women, no less!—she wasn’t exactly met with open arms (or veins). But Lady Montagu persisted, inoculating her daughter in front of witnesses (the process wouldn’t be called “vaccination” for some time) as proof that the procedure in fact happened, was no hoax, and, later, that it would protect little Mary from the dreaded smallpox.

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There’s an important point to make here before we go on, and it’s one I learned from Sudan, whose Alchemy of Empire makes the following case in great detail. In many ways, Montagu’s actions constituted colonization of medicine, or cultural appropriation, if you will. When Montagu brought the practice of “engrafting” or “inoculation” back to Britain, it was indeed met with a great deal of skepticism, largely because the procedure was developed in a foreign land. This Eastern process involved scooping matter from an infected smallpox wound, lancing the arm of a healthy patient, and smearing the matter in. It literally involved accepting a foreign element into one’s body to protect oneself against fatal illness. In fact, Sudan describes Montagu as a woman whose self-avowed “patriotism” made her willing to “seek foreign techne in order to counteract smallpox.”⁴ Xenophobia (I told you we’d get back to this) had to be put aside if one wanted to live and, much more important, to save the nation as a whole from being overcome by disease. Montagu realized this. But these fears ran deep, as according to Sudan, “many Britons read inoculation as an unpatriotic act, a treasonous introjection of the elements of disease into what they perceived as the healthy corpus” of Britain.⁵ It wouldn’t be until the 1790s that the process would be more widely embraced, after Edward Jenner used the less virulent cowpox, derived from the wholesome dairy fields of England itself, to confer smallpox immunity.

So, while Montagu’s openness ought to be applauded, it’s also incredibly important to note the ways that this foreign, female technology was met with approval only when it was rebranded as a Western, male technology. Now, as many modern scholars take pains to point out, inoculation practices existed in many different cultures before Montagu’s time—a 1700 letter from a British merchant mentions the practice as having existed in China for at least a century, and as early as 1731, employees of the East India Company noted its existence in India (though the practice itself was ancient). Cotton Mather mentioned learning about it from his African servant.

So, not only did inoculation-style techniques exist long before Montagu learned of them but she was hardly the first person to point it out to the British, either. Nevertheless, it was Montagu who refused to stop until doctors listened to her, and it was she who publicized and popularized the practice in Britain by virtue of sheer determination (and, let’s be real, probably her aristocratic social position). To this day smallpox is one of the very few diseases considered to be truly eradicated from the planet, and even if it didn’t quite start with Mary, her willingness to learn from other cultures played a large part.

And this is the lesson we can learn from Montagu:

LESSON 1:

Listen. To. Women.

Or, more to the point, we should always be looking for innovations from the people we might not be accustomed to listening to. As a medical humanist, I see my job as one that asks scientists and doctors to consider how they’re framing questions, to see what implicit biases might be limiting their data analyses by limiting what they’re even looking for in the first place. In this case, the bias seems simple, possibly preposterous: if a few men in the 1720s hadn’t been willing to listen to a woman promoting foreign technologies, we might have been greatly delayed in widespread use of vaccines. However, this example seems straightforward only because we no longer blatantly ignore women’s intelligence in the brazen way that was socially acceptable three hundred years ago. This doesn’t mean that we are free of our own cultural biases.

One example of what this might look like in the age of COVID-19 is to consider that Western science often locates epidemic origins in non-Western spaces (Asia and Africa) and is quick to cite non-Western practices (eating certain meats, for instance) as their cause. It’s not my place to judge the accuracy of these claims, but as a scholar of medical humanities, it is my job (and the job of many others who have made similar cases) to urge epidemiologists to check and recheck every layer of their quantitative research design—yes, even their statistical algorithms—for evidence of bias or oversight. As moral creatures, we have a responsibility to make absolutely certain that our repeated findings of Asian and African origins for diseases like Ebola, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), swine flu, avian flu, and COVID-19 are not a result of some social bias built into our statistics, because prejudice is possible even in math. The tools are only as good as the tools’ users and their creators, and whenever your open-ended research turns up the same answer again and again and again, only the most reckl...