Thoughts on economics and liberty

Op-ed by Edwin Chadwick against lockdowns and quarantines – 17 September 1883

This op-ed by Edwin Chadwick, originally published in The Pall Mall Gazette was reproduced in the Sydney Morning Herald on 17 September 1883:

QUARANTINES

The Pall Mall Gazette has received the following communication from Mr Edwin Chadwick, CB –

I am induced, chiefly by the opinions acted upon on the continent in relying on quarantine for the protection of populations from the pestilence of cholera, to submit a brief statement of some experiences that may serve to elucidate the subject.

The first General Board of Health being charged with the preparation of defensive measures against the epidemic of cholera, which befell the country in 1848 and 1849, the course we took was not to act upon any opinion of our own, but on the most carefully collected experiences we could get.

For this purpose we examined officers who had served amidst the heaviest visitations in India as well as at home. We examined them especially as to what in their experience did do, as well us what did not do. Of the measures which did not do there was a unanimous declaration that quarantine had everywhere failed to check the advance of the pestilence. Quarantines, they declared, were of as little avail as they would be against the east wind.

Of measures that did do, there was unanimous testimony in favour of cleanliness or sanitation.

In the advanced stages of the disease medicine was of no avail. But we found, for the first time, that the pestilence was preceded by conditions of generally felt bodily depression, or by premonitory symptoms which did admit of a dietetic and medical treatment, which, when combined with or preceded by measures of sanitation which reduced foul atmospheric conditions, was always effectual.

In the prosecution of the preventive measures of cleanliness throughout the country some places were found to be so intensely filthy with the filthy walls of houses and excrement-sodden sites that the immediate measures, of prevention were declared to be impracticable, and the only available course was to remove the population out into tents which we borrowed from the army stores. After a time some of the people got tired of bivouacking and went back into the town, when they were attacked with premonitory symptoms. They returned to their tent and were relieved; they ventured back again to their homes and were attacked, they returned to their tents and were relieved.

“Now, what we should have done according to the practice now prevalent in Egypt, and adopted for Italy. Spain, and even for France would have been to surround such a place with a strict cordon, to enforce quarantine, and have confined the people in their poisoned atmosphere. The Northern circuits were pursued during the cholera period, many members of the Bar were, while in a town visited by cholera, subject to premonitory symptoms in the affected places, London having them and getting into less impure atmosphere were freed from them. On the Egyptian practice they would have been confined to those infected places by a cordon of soldiers, and shot down impartially if they attempted to pass it. At a recent meeting of the Epidemiological Society a paper was read by Surgeon General Cunningham, chief sanitary officer of the Government of India, presenting the largest and widest and latest experience of the world on “The Sanitary Lessons of Indian Epidemics,” entirely confirmatory of our course and directly condemning the practice of the so-called boards of health in Egypt as false in theory and barbarously mischievous in practice.

Besides the people who were tented out from infected places, there were others who went away, as they were left to go where soever they pleased to unaffected places The contagionists and adherents of the quarantine theory would declare that they must have spread the epidemic from new centres. But we heard of no instances of this being true, and we certainly should have heard of it ‘with a vengeance’ had any such consequences followed from the entire freedom from quarantines.

“The pre-eminent success of our measures, so far as we were enabled to carry them out through defective local agencies, was measured by comparison with the mortality from the epidemic in other equally death-rated countries on the Continent, and tried by that test upwards of 50,000 lives must have been saved by those same measures. By them, as executed by three of the lieutenants of our board, or by two – Dr John Sutherland, and Mr Robert Rawlinson – a third, Dr Hector Gavin, having been killed by an accident, the death-rate of the first army in the Crimea was reduced from thousands to hundreds in the second, and – as declared in Parliament by the Minister of War – was in a better state of health than it had ever enjoyed at home. By them, consequently, and chiefly by the application of sanitary principles to the most effectual ventilation of the military barracks and hospitals and by other rudimentary measures promoted, especially in India, where the death rate has been reduced from 69 to 20 per 1000 during the last decade, a saving has been effected of 28,000 men, or of double that number of cases of invaliding from sickness, or altogether a saving of more than 40,000 of force, and of more than five millions of money.

“But I beg to present for our own information, as well as in the way of example to our Continental neighbours, information as to our progress in rudimentary work for the prevention of the epidemics we have always with us, as well as against extraordinary epidemics. We have now had engaged, chiefly during the last decade, more than seventeen hundred officers of health, and between sixteen and seventeen hundred inspectors of nuisances, and about one thousand surveyors engaged under the local authorities, with yet very imperfect and rudimentary results. During the last decade they have done little more than touch the edge of sanitation as it were, in the removal of cesspools and the more outrageous nuisances, leaving ill-drained and overcrowded houses and badly distributed supplies of water for future work. Let it be considered how much larger force would be needed on the Continental system in for the maintenance of cordons sanitaires, internal as well as external by quarantines, which aggravates instead of mitigating the evils to the population. It may be proper to cite for general information the following statement of the Registrar-General of the results in the reduction of the diseases almost exclusively acted upon by the present sanitary service. He says in his last report that ‘there is nothing in the series of annual reports issued by this office that comes out more distinctly and unmistakably than the wonderful effects which the sanitary operations of the last decade have had in saving life.’ He gives statistical details in support of this statement, and he then states that ‘had the death rate remained as it was during the preceding decade the total deaths from 1871 to 1881 inclusively would have been 5,548,116, whereas they were no more than 5.155.367. Thus no less than 392,749 persons who were under the old regime would have died were still living at the close of 1881.’ Added to this it is shown by the last census that during the last decade there has been a gain of two years in the duration of life of the population of England and Wales, mainly ascribable to the rudimentary works of sanitation.”

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Sanjeev Sabhlok

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