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5— The International Quarantine Board
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The Maritime Quarantine System

The maritime quarantine system consisted of three instruments: the bills of health issued to ships on departure from port; the periods of detention, called quarantines, imposed on ships, passengers, and cargo originating in ports judged infected with disease; and the facilities for detention and isolation called the lazaretto. The issuance of bills of health designating the ascertainable state of health in a ship's port of origin was the principal measure for preventing exportation of plague, an "international intelligence network" to alert authorities in the port of debarkation to the possible danger of infection abroad. All major trading nations maintained sanitary authorities at their chief ports in communication with the Mediterranean: Marseilles and Toulon in France, Trieste in Austria, Odessa in Russia, and the principal ports of the Italian states. After 1815, England required vessels from the eastern Mediterranean to undergo quarantine at Malta before proceeding to the British Isles.

According to Italian ports' usage, vessels were issued passes in four denominations: "unclean" or "foul," designating a port where plague existed at that time; "suspect," indicating a recent incidence of plague at the locale or on board ship; "clean," if the port of origin had no incidence of plague for forty days; and "free," if the ship came from a land where there was not even a suspicion of plague. The latitude for error, disagreement, and deception in such a system is obvious. And there were frequent complaints that quarantine officials could be induced to falsify information or to waive regulations for sufficient compensation.[3]


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The Venetian system of quarantine, which became the model for most other sea powers, was based on the experience of some seventy plague epidemics in 700 years and rested squarely on the conviction that infection was carried in shipments of goods. Venetian regulations provided for the isolation of plague-stricken passengers, fumigation of their personal effects, and purification of the cargo carried aboard ship. Paralleling the designation of clean, suspect, and foul bills of health, goods were classified as materials not susceptible, doubtful, or susceptible to absorb infection. The quarantine period of forty days apparently was based on the belief that it took this length of time to dissipate the infection absorbed in merchandise by exposing it to sunshine and fresh air. Rules for purification varied according to the commodities' supposed degree of susceptibility, but in the course of time, the classification of goods had been elaborated to the point of absurdity.[4]

Nevertheless, it was the only system extant for attempting to mitigate the threat of pandemic killer disease. The twentieth century would acknowledge the value of early international disease control efforts, unaware that the viceroy of Egypt had commissioned the first international Quarantine Board in Alexandria in 1831. It was a common assumption, according to one international health official, "that the board is a body originally imposed on the government of Egypt by the European powers."[5] In fact, Muhammad Ali had adopted the principle of quarantine before any European consular representatives arrived in Egypt. Maritime quarantine was an old, familiar idea throughout the Mediterranean, and as early as 1812, his Italian physicians had persuaded Muhammad Ali to restrict the entry of ships from Turkey when plague broke out in Constantinople.

Alarms about the threat of plague from Syria and Asia Minor recurred and stimulated the establishment of quarantine stations in Alexandria in 1828, in Damietta in 1829, and in Rosetta in 1831.[6] But Egypt lacked a lazaretto, which Mediterranean Europe considered an essential defense against plague. The lack of a lazaretto became a serious handicap for the viceroy after his campaign in the Levant because it was impossible to import commodities from Syria and Asia Minor without such a facility. Persons and goods had to remain on board ship for forty days; if the vessel was not carrying sufficient provisions for that length of time, the ship's captain often returned to his port of debarkation or made for another harbor where quarantine was not enforced.[7] Since plague appeared almost every


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year in Syria or Asia Minor, this meant inordinate delays and losses in delivering materials from the viceroy's Syrian dependency.

When the consular Quarantine Board reconvened after the cholera epidemic in 1831, therefore, Muhammad Ali specifically charged the members to create a European-style lazaretto as the core facility of an effective quarantine system. The board accordingly drafted a comprehensive program that stipulated that the lazaretto would be modeled on the best European facilities, that all its principal employees would be European, and that ships' and passengers' fees would be calculated to cover the cost and maintenance of the establishment. An outbreak of plague in Damietta spurred lagging construction, and the new lazaretto was in operation by January 1833.[8]

In view of the role the pilgrimage was to play in carrying cholera from South Asia to the Mediterranean via the Arabian peninsula, it is important to note that Muslim pilgrims' movements constituted the bulk of traffic through Alexandria's lazaretto from the outset. In January 1833, 2,000 pilgrims were quartered in the lazaretto, Muslims from all parts of the Ottoman Empire and a large number of Russian Tartars from the Black Sea area. All pilgrims transiting Egypt thereafter routinely stayed in the lazaretto before setting out on the caravan to Mecca, and the Egyptian government provided sustenance for the poorest among them. The British consul general, who visited the lazaretto at that time, found the travelers' quarters "clean and convenient" and ample enough to accommodate 2,500 persons.

The lazaretto compound also included warehouses for quarantined goods and a small garrison of soldiers to guard the merchandise and to prevent communication between the lazaretto and the city. Duties were levied on ships according to tonnage, on cargo according to "susceptibility" to contamination, and on passengers according to the number of persons in a group requiring accommodations. These duties amounted to considerable revenue; in 1833, it was estimated that ships in quarantine paid an average of $14,000 to $15,000 annually in quarantine fees, which were applied toward the lazaretto's operating expenses. Salaries for personnel was the largest single expenditure; the lazaretto and its subsidiary bureaus employed 19 Europeans, 47 Egyptians, and 80 Egyptian guards.[9] In spite of seemingly sufficient staff and operating funds, this was the establishment that, fifteen years later, proved inadequate to handle the great influx of pilgrims who brought cholera into Egypt and sparked the epidemic of 1848.


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One obstacle to efficiency in the quarantine service operations was the difficulty of gaining agreement among Quarantine Board members for consistent policy enforcement. The situation became clear in 1838 when the board's first elected president found his attempts to enforce regulations blocked by his colleagues' defensiveness in protecting their national prerogatives. One source of friction developed in the relations between the quarantine services in Alexandria and Syria. Following the Alexandria board's recommendations, Ibrahim Pasha had established quarantine stations in Syrian ports, and his commander in the Levant, Sulayman Pasha, apparently enforced the regulations with a military rigor resented by local consuls and merchants alike.[10] When the board's president proposed that, since intelligence from Syria indicated that plague had appeared on the coast, all ships from the Levant should be placed under observation on arrival in Alexandria, his colleagues disagreed. Their consuls in Syrian ports were issuing clean bills of health, which they felt should permit their ships free entry. Instead, they called for discussion of travelers' complaints and merchants' reports of discrimination in the lazaretto's operations. The Quarantine Board members also refused to uphold the president in firing quarantine service employees, who apparently were consular protégés, for malversation of funds. Finally, the president resigned when Board members passed a resolution that their ad hoc rulings could waive any of the board's statutory regulations.[11]

Histories of the quarantine service claim that at this point, angered by the European powers' rejection of his bid for independence from the Ottoman sultan, Muhammad Ali decided to withdraw the prerogatives he had granted the consuls in 1831.[12] No doubt the pasha was aware of the board's proceedings. An opportune moment to intervene arose at the end of 1839 when a Turkish ship from Smyrna that arrived in Alexandria with a clean bill of health was placed in quarantine, while an Austrian steamship that arrived from the same port on the same day was granted free entry. Muhammad Ali promptly notified the board that the quarantine service had been regularized sufficiently so that henceforth it could be administered by the Egyptian government.[13] Muhammad Ali's move to nationalize the Quarantine Board was to prove short-lived, in view of his impending defeat in Syria, but it temporarily and partially Egyptianized the agency. In 1840, the Egyptian liaison officer, Tahir Effendi, was named permanent president. And in August 1841, the board was de-


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clared responsible directly to the viceroy. Two months later, Muhammad Ali had to reaffirm the sovereignty of the Ottoman sultan, and the Egyptian board technically became subordinate to the sanitary administration in Constantinople.[14]

In the meantime, European consular agents had refused to recognize the board's authority or the validity of bills of health issued by the Egyptian police. Their ambassadors in Constantinople secured an order from the sultan demanding the viceroy's adoption of the Ottoman board model, which included official European representation.[15] With his customary pretext of lacking directives from the Sultan exploded, Muhammad Ali had to concede European consul's participation in the agency. A new decree in November 1843 invited the consuls general of Austria, France, Great Britain, Greece, Prussia, Russia, and Sardinia to name delegates to a reorganized board. Egyptian government appointments included the minister of war, Khurshid Bey, and Shaykh Khalil Ghazali, counsel for canonical law and popular religious beliefs. The viceroy's chief secretary pointed out that there was no hope of moderating the rigorous quarantine measures imposed on Egyptian commodities in European ports, which severely handicapped the country's commerce, as long as foreign nations withheld their confidence in Egypt's sanitary administration.[16]

In the 1840s, the rising volume and speed of international trade caused by the expansion of steam transport provoked a strong challenge to the time-honored practice of detaining ships from localities where plague prevailed. Commercial interests in France felt particularly disadvantaged, for England and Holland had long virtually ignored quarantines and Austria followed suit early in the nineteenth century, apparently relying on land controls along the border with Turkey to exclude plague. Following the first invasion of cholera in 1831, the stringent quarantine measures elaborated after the Marseilles plague of 1720 had been renewed at precisely the moment when England took a long step to outstrip France in the trade race by launching the Peninsular and Oriental Steam Navigation Company. Increasing pressure by shipping interests then caused the French government to commission the Academy of Medicine in 1844 to examine, and if possible to revise, the Marseilles code. The academy attached great weight to the evidence of experts with experience in Egypt, as we have seen, and it accepted the investigating commission's conclusion that plague was not transmissible from person


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to person. The commission further asserted that there was no convincing evidence that plague could be transported in merchandise. Persons stricken could vitiate the air of ships, creating a localized "pestilential constitution," but imported plague could not cause a serious outbreak unless favorable climate and sanitary conditions existed.

Health authorities in Great Britain also upheld a noncontagionist view that an "epidemic atmosphere" might extend over thousands of square miles and yet affect only particular localities—those in an unsanitary state. On this hypothesis, quarantine was no safeguard for the public health but was an obstruction to commerce. England therefore officially abandoned quarantines and exclusively relied on local sanitary improvements.[17] In both countries, the opinion gained ground that quarantines were not only useless but were, in effect, institutionalized instruments of extortion. Bowring's judgment that "ignorance instead of safety, evil instead of good pervade the whole field of sanitary legislation" epitomized the progressive's reaction to the inconsistencies and excesses of antiquated quarantine practices.[18]

Countries in the western Mediterranean, unconvinced by the evidence advanced and holding enormous vested interests in quarantine establishments, refused to follow the lead of the Atlantic seaboard nations in abolishing maritime quarantine. Specifically, in regard to Egypt, reports that the annual plague outbreaks had waned to the vanishing point after 1842, a trump card in the arguments for eliminating quarantines, aroused strong skepticism. During the 1840s, several European govenments sent special envoys to observe actual health conditions in Egypt and to assess the effectiveness of the quarantine service operations.[19] It was difficult to reconcile the idea of plague's disappearance with the notion held for so many years that Egypt was the cradle of plague.

Muhammad Ali therefore attempted to respond to two opposed viewpoints, both of which incriminated health conditions in Egypt in disease causation, so as to gain the "confidence" required for uninhibited commerce. On the one hand, he upheld a maritime quarantine system that was extremely disadvantageous for Egyptian trade. During the decade from 1834 and 1844, when Egypt was rarely completely free from plague, vessels carrying Egyptian commodities routinely were denied clean bills of health and were subject to long periods of detention in European ports. On the other hand, trading nations unconcerned about contagion were wary of the "pestilential"


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or "epidemic constitution" that they believed arose from unsanitary conditions in Egypt. The sanitary reform introduced in Alexandria in 1842 and theoretically projected for future implementation in other major cities seems to have been the viceroy's attempt to disarm those objections.


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