Was Quarantine Effective Protection Against Plague?

Opposed to Dr. Clot and his noncontagionist colleagues' evidence of their failure to transmit plague by exposure, contact, and inoculation, the contagionists could only point to the (admittedly relative) immunity of those who went into seclusion during the epidemic. The issue was: were the quarantine procedures enforced by the Egyptian government effective at all or were they, as the Egyptians no doubt saw them, simply additional hardships inflicted on an already suffering populace? On this point, Clot and his miasmatist colleagues were weak, for positive evidence outweighed the negative, and the establishments that escaped plague during the epidemic were those isolated from the community. The Music School at Khanka, ordered into quarantine in an old army depot, had no plague cases among its students, and the Polytechnic School, where Hekekyan-Bey personally stood guard, was spared throughout the epidemic. Both the Arsenal, where 6,000 workers were effectively detained by a military cordon, and the viceroy's palace at Shubra,

where elaborate restrictions were enforced, were struck only after quarantine regulations were lifted.^[72]

The partisans of noncontagion neglected to mention in their writings what the European consuls reported in 1836: plague broke out primarily among those who had been quarantined the year before—workers in the Arsenal, navy personnel, and students in schools. Clot wrote that in spite of rigorous quarantine maintained over 300 inmates at Shubrah Palace, three servants died of plague; but he failed to specify that the deaths occurred in 1836, after quarantine had been lifted.^[73] The miasmatists also allowed no margin for human error or neglect in the preventive measures and declared that a single case of plague in an establishment under quarantine invalidated the principle of isolation. Clot's colleague, Aubert-Roche, emphatically denied the efficacy of protective barriers and asserted, "It is wrong to say the Mahmudiya hospital did not suffer from plague; after six months of quarantine, one of the orderlies was attacked."^[74]

Although neither side to the dispute recognized it at the time, the cumbersome, hit-or-miss quarantine procedures traditionally excluded and destroyed stray animals, which must have kept infected rats and fleas from the segregated premises. The government regulations also eliminated fleas by burning clothing and bedding used by the plague striken. For populations at risk, like the 6,000 workers at the Arsenal, government measures extended to leveling their huts and building new barracks, or at least cleaning, fumigating, and whitewashing the dwellings.

Although it had proved infeasible to enforce controls over all the citizens of Alexandria or Cairo at the peak of the epidemic, as we have seen, the viceroy allowed no relaxation in restrictions on government service personnel. The British consul general, Patrick Campbell, reported that "the Pasha gives every support, as well by his example, as by his orders, to the efforts of the Quarantine Board." During his presidency of the board, Campbell had quarantined the entire Twenty-second Regiment garrisoned in Alexandria for eleven days when a single case of plague broke out in the unit. He also ordered the admiral of the fleet quarantined, and we know that the order was enforced, for government records include an official reprimand to the admiral for protesting the restriction. Two ship commanders were sentenced to seven years penal labor for breaking quarantine before the end of the prescribed detention period. And

when one of Ibrahim Pasha's officers in Syria reportedly violated quarantine, he inquired what penalty European regulations prescribed; informed the usual punishment was death, he had the officer summarily tried and executed.^[75]

As for the pasha's daughter-in-law who was quarantined, Muhammad Ali ruled his own family with an iron hand and there was no question of noncompliance with regulations. When Saïd accompanied the fleet to Crete, provincial officials decided to waive quarantine restrictions for the young prince, but his first question on arrival was how many days of detention he had to undergo.^[76]

In November 1835, the Quarantine Board issued new regulations "to avoid misunderstanding" in future outbreaks of plague. All houses where plague appeared would be placed in thirty days quarantine and fumigated. Stricken individuals with means could be attended by their own physicians, while those in need would be removed to the lazaretto and attended by the Quarantine Board's medical officers.^[77]

It appears that Europeans resident in Egypt later followed the Egyptians' example of hiding the sick or the dead during an outbreak of plague,^[78] but at this time, it was common for them to resist quarantine by force. These incidents often became armed confrontations between Quarantine Board officials and police, on one side, and a crowd of supporters for the family threatened with detention, on the other. We are told that the viceroy, "tired of these scenes," instructed the police that in cases where Europeans resisted enforcement of regulations, they should call on them three times to comply and fire if they continued to resist after the third summons.^[79]

The enforcement of domestic quarantine for plague ceased to be a major problem when the disease mysteriously declined in the 1840s. But the main point of contention between miasmatists and contagionists—the necessity for maintaining traditional maritime quarantines—remained a bitterly disputed issue, seriously impeding efforts to control outbreaks of cholera, which, unlike plague, continued to ravage the civilized world throughout the nineteenth century.

The history of the international Quarantine Board that Muhammad Ali commissioned in 1831 reveals that in the dispute over quarantines, economic and political factors shaped the board's policies, rather than technical or humanitarian. We shall survey that history next.