Fighting Ebola the Medieval Way
As the Ebola epidemic claims new victims at an ever-increasing rate, African governments in Sierra Leone, Guinea and Liberia have instituted a "cordon sanitaire," deploying troops to forcibly isolate the inhabitants in an area containing most of the cases.
Will this work? Some commentators, such as the New Republic's Laurie Garrett, contend that it could stop the spread of the disease, citing a 1995 outbreak in Kikwit, Zaire. In that instance, the dictator Mobutu Sese Seko cordoned off the city in order to stop the disease from spreading.
Putting aside the fact that the 1995 outbreak was small and localized, whereas the current epidemic is now raging in several places, the cordon sanitaire -- also known as a "shotgun quarantine" -- has a distinctly mixed historical track record.
Unlike an ordinary medical quarantine, which isolates sick individuals along with others who are afflicted, the cordon sanitaire makes no such distinction. It treats the sick and the well in an identical fashion, forcibly keeping an entire population from entering or leaving an area.
Cordons take two forms. The first is known as "defensive isolation," in which a healthy population walls itself off from everyone around them, forbidding the entry of any and all. The second kind is so-called "offensive containment." This strategy, now being deployed in Africa, tries to encircle the outbreak of a disease, preventing anyone from leaving the affected area.
That these tactics resemble medieval siege warfare is not accidental. After the Black Death arrived in 14th century Europe, a number of Italian city states sought to create an elaborate cordon sanitaire system to fend off future onslaughts of the disease.
Principalities in the northern part of Italy took the lead, according to historical geographers Andrew Cliff and Matthew Smallman-Raynor. These places, while strategically situated to profit from the trade between Europe and Asia, also happened to be the first places come down with illnesses brought by travelers from afar, particularly the plague.
Devastating outbreaks of the Black Death led state administrators to construct a three-tiered system of defenses that would effectively keep out potential disease carriers. These included patrol boats on the Mediterranean and Adriatic; a network of towers on the coastline; and cavalry troops on land. These defenses, when coupled with an elaborate surveillance system, aimed to keep disease at bay.
The system often worked better than one might expect. Its success owed much to early planning: city elders put these defenses in place well in advance of epidemics. Likewise, they created a cadre of trained "Health Magistracies," offices whose mission was to oversee plague prevention defenses. They also built an elaborate surveillance system relying on spies, as well as information-sharing protocols linking the principalities.
A comparable system of defenses was built by the Hapsburg Empire from 1728 to 1790. In a series of edicts known as the Pestpatente, state authorities built a cordon sanitaire along the border with the Ottoman Empire that stretched over a thousand miles.
According to scholar Geoffrey Hawthorn, an army of peasants manned the frontier at all times in addition to 4,000 regular soldiers. Travelers who failed the follow the rules and regulations governing the cordon were considered a threat to public health and dealt with accordingly: they were shot. And that was in normal times. When the Hapsburg bureaucracy got word that the plague was on the march in the east, they would increase the number of soldiers to 7,000, and ultimately 11,000, enabling them to set up guard posts within shouting distance of one another along the entire cordon.
By contrast, the quarantine now being implemented in Africa is a makeshift, haphazard affair, relying on untrained soldiers and the naive belief that shutting down the main highways will be sufficient to prevent infected people from breaking the cordon. This is preposterous.
The problem, then as now, is the logistical challenge of completely eliminating any movement in or out of a large territory. One critic, writing in the 1880s about cholera outbreaks in Europe, observed that officials could "close every railroad line and every Alpine wheel route," but refugees "would improvise a hundred footpaths through the mountains to find a way home."
Moreover, the use of a cordon sanitaire in the past, while ostensibly aimed at restricting the movement of people, often had the opposite effect. In the Egyptian cholera epidemics of the late 19th century, imperial administrators used the cordon sanitaire, only to find that it panicked the populace. Many people fled the area out of fear that they would perish if left behind.
In addition, the cordon sanitaire has a rather unsavory history in western Africa, where it was used in places such as the Belgian Congo to fight the spread of trypanosomiasis, or sleeping sickness, in the early 20th century. These heavy-handed tactics, combined with a campaign to forcibly inject people with atoxyl, a medication that left nearly third of patients blind, destroyed what little faith natives had in efforts to combat the spread of disease.
Yet perhaps the biggest problem with the cordon sanitaire is its brutality. While invariably justified with the language of expediency, the cordon sanitaire has often doomed huge numbers of otherwise healthy people to certain death. It is perhaps not surprising that by the late 19th century many people came to denounce the practice as a relic of the Dark Ages.
Their words make for interesting reading today. Here, for example, is how the Encyclopedia Britannica defined the "semi-barbaric and brutal" use of the "shot-gun quarantine" as early as 1888: "an unscientific if not a lawless procedure indulged in by panic-stricken inhabitants who, with deadly weapons in their hands, threaten to shoot any person from an infected district who seeks to enter or pass through their lines."
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