This chapter delineates a crisis of public health that occurred throughout the Revolutionary and Napoleonic Wars. It shows how it was in response to this crisis that the modern system of universal quarantine took shape. The chapter investigates the series of plague and yellow fever epidemics that breached the defenses of a string of Mediterranean islands and considers the response of European governments. The frequency with which armies and navies crossed the Mediterranean created a massive augmentation of quarantine traffic just as new epidemic threats emerged. Authorities recommitted to a robust approach to quarantine in light of these challenges. Despite wartime debacles that suggested the system might break down, Chapter 1 shows that it emerged stronger than ever. In this way, we see how a brutal series of wars and epidemics counterintuitively fostered transnational sanitary cooperation.

In this chapter, the perspective shifts to the travelers, traders, sailors, soldiers, merchants, and missionaries whom quarantine detained. It begins with an analysis of the demographics of Mediterranean quarantine. It then considers incidents of suspicious deaths in the lazaretto, ghostly experiences that frightened travelers, and the routines developed by those in quarantine to ward off boredom. The chapter also investigates sanitary crimes, including attempted escapes, smuggling, and entrance into prohibited spaces. By combining administrative records, travel accounts, private letters, and diaries, and through the use of evidence from numerous quarantine stations, the chapter presents an original comprehensive analysis of the experience of quarantine in the modern era.

More than two hundred years ago, in 1801, Marseille lay burning in the sun. Its harbor was full of the eerie spectacle of ships sitting silently, onto which no one boarded and from which no one disembarked. The most crowded spot in the city was not one of its public markets, squares, or churches, but a massive complex that sat on its northern edge, abutting the sea: the Lazaretto of Arenc. This fortress, at the time, served as France’s most important quarantine station. It was legally mandated as the reception point for almost all ships and passengers entering the nation from the Middle East and North Africa, and employees there prided themselves on their efficiency and rigor in managing the threat of bubonic plague.

This chapter makes a case for the existence of a cohesive “British Mediterranean world” that encompassed not only Britain’s Mediterranean colonies (in this period, Malta, Gibraltar, and the Ionian Islands) but also the intrigue and influence the Mediterranean exerted in Britain itself. We consider the diverse ensemble of British personnel driven to the Middle Sea by the obligations of military service, by the needs of diplomacy, or by personal inclination. The chapter demonstrates that it was primarily attention to and interest in Mediterranean dynamics that shaped the course of Britain’s attitude toward quarantine. Finally, in considering the “Doctor’s Mediterranean,” it concludes with a study of the ways in which medical expertise developed in the Mediterranean region impinged in an outsized manner on British debates of the validity of quarantine.

Chapter 6 explores to the ways Ottoman subjects and Western Europeans residing in the Middle East contended with actual plague epidemics and argues that Western conceptions of plague informed their broader evaluations of the Ottoman Empire. The chapter examines how easily diplomatic conundrums filtered into the casual discourse of travelers and how closely medical and political evaluations were intertwined. Plague helps open up the Eastern Question by making clear how the political dilemmas it posed were not the exclusive purview of high diplomacy but were deeply implicated in medical and cultural perceptions of the “East.” It was possible, we see, for Western Europeans to construct the presence of plague as a central civilizational dividing line even as Ottoman and Western responses to the disease were relatively similar.

In the 1850s, the character of Mediterranean quarantine fundamentally changed when it lost its role as a universal barrier. This chapter explores both the end of the universal quarantine system in the Mediterranean and its influential afterlife. It was because of the tight links among boards of health that governments conceived of an international medical conference as the only way quarantine could be reformed. The first such International Sanitary Conference (1851) is widely recognized as an influential moment in the creation of the idea of international health. After 1851, though quarantine remained a tool within a later medical and political arsenal, it was no longer a universal European checkpoint against all arrivals from a specific region of the world. The chapter shows that the end of the system of mandatory quarantine had at least as much to do with the decline of plague in the Middle East as it did with the ascent of anticontagionist arguments in London, Madrid, Paris, or Vienna. Universal quarantine set down geographies of exclusion that have proven enduring. Yet, in global terms, it was primarily after the end of this universality, in the later nineteenth century, that quarantine effectively became a tool for targeting specific individuals, races, and ethnicities.

This chapter takes a transnational approach to the study of the administration of quarantine, considering the how boards of health had to operate along local, national, and international registers. Through a social and institutional study of quarantine administration, it becomes clear how boards in different countries negotiated problems in symmetry. The chapter explores the administrative logic underlying disinfection practices and the daily scope of board of health activities. Lazarettos comprised a rigid hierarchy of employees, from the “Captain/Prior” in charge of the building through doctors to the “guardians” who attended each traveling party and who cycled in and out of quarantine themselves. At the top of the hierarchy, boards of health wielded immense power as they acted as local administrators with an international remit. I investigate how the lazaretto could simultaneously serve as an economic engine for cities such as Marseille, a civic institution, and a space that fell within the interstices of administration, whose jurisdictional status remained murky.

Chapter 7 highlights the centrality of the history of Mediterranean plague and quarantine to the birth of the public health movement in Britain. Even though bubonic plague is often considered to be a premodern problem, its diffuse and dramatic reputation thoroughly shaped conceptions of other nineteenth-century killer epidemics –– cholera in particular. The chapter reconsiders the much-discussed “contagion debate” within this wider, transnational genealogy of public health. The fight between those who believed epidemic disease was communicated by contact and proximity (“contagionists”) and those who believed that epidemics spread because of atmospheric factors, such as temperature, winds, marsh exhalations, or other putrefying matter (“anticontagionists” or “miasmatists”) has achieved a tired reputation in recent historiography, which casts it as professional posturing in the midst of broad agreement. While this may be true when it comes to cholera, by focusing on quarantine and plague, the broader significance of these medical arguments is more readily apparent. In part thanks to quarantine, public health reformers tended to present problems in explicitly national terms or within dichotomies of national versus foreign. Because of the way they undergirded this national framing, plague and quarantine are an influential part of the genesis of what has been called the “Condition of England Question.”

Chapter 8 shows how British imperialism spread quarantine practice to new areas of the globe. We examine British responses to plague epidemics in Malta, Corfu, and India. I argue that British use of quarantine in these imperial contexts demonstrates how firmly inflected by Mediterranean practice the global response to epidemic disease had become, even as quarantine was implicated only in very specific contexts. Particular attention is paid to the way in which imperial medical practice in response to the plague (particularly in Northern India in the mid-nineteenth century) fused approaches from both the contagionists and the anticontagionists.