The Colonial Roots of International Disease Management
In their handling of the Covid-19 pandemic, President Trump and his allies are calling plays from an old playbook.
Wong Chut King couldn’t have known why he felt so warm. His billowing black shirt and pant stuck to him like tar, and he was grateful for the damp coolness that trickled into his room from the sidewalk above.
Dreams didn’t come easy that night. Burning incense mixed with the scent of his vomit and feces, creating a putrid miasma that made it even harder for his fluid-filled lungs to breathe. His body ached to the bone, every inch of skin prickling with heat. The wooden slab he used as a bed was slick with sweat and grime, and his desperate cries for help went unheard.
Wong moved to America sometime in the 1880s, sending the bulk of what paltry income he earned in San Francisco’s lumber yards to his wife and family in China. He lived in a building crammed with nearly three hundred other Chinese immigrants. Turn of the century California was a hostile place for Asian immigrants. The mayor of San Francisco pledged to “Keep California White,” and the state’s Sinophobic legislature nudged Congress toward passing the Chinese Exclusion Act.
Wong spent his last hours in a dizzying frenzy of fever, delirium, and pain. It’s impossible to know what he felt before slipping into a coma. Perhaps shame or guilt (he initially sought treatment for a sexually transmitted disease). Maybe relief that his suffering was at an end. Or was he proud of the sacrifices he made to give his family a better life?
On March 6th, 1900, Wong Chut King died, becoming the first-ever case of plague in the United States.
Once alerted to a potential case of plague, city officials forcefully responded. Residents of Chinatown awoke to ropes and police officers. Nearly twenty thousand people, confined to a space of less than one square mile, trapped. If any attempted to flee, police beat them with a baton. After two terrifying days, the city lifted the quarantine, but the Asian community became lepers in a city that hardly knew they existed.
White residents had a very different experience. In its March 9th edition, the San Francisco Chronicle wrote:
The general public, having nothing at stake but its health, laughed and demonstrated its lack of fear for the Health Board’s bubonic bogy by crowding every avenue into Chinatown.
Plague? What plague? It’s nothing more than a ruse to drain the city’s coffers! Even the U.S. Surgeon General says the disease is “peculiar to the Orient, and seldom, if ever, attacks Europeans.”
One would be hard-pressed to spot the differences between those who paraded around Chinatown amid an outbreak of plague and the anti-lockdown protesters who cry tyranny when asked to go without a haircut for a month or two. Both are examples of white privilege and America’s obsession with individual liberty. Acting in one’s self-interest is as American as apple pie, but San Francisco’s racially motivated quarantine and the simmering Sinophobia we see today have their roots in something deeper and more immutable.
The British are responsible for some of history’s most significant innovations: the steam engine, the telescope, the vaccine, the crumpet. The British Empire also pioneered colonial medicine (decidedly not as innovative as the crumpet).
In 1764, The Crown created a new branch of the military to oversee and provide health care throughout the Indian colony, known as the Indian Medical Service. IMS physicians were trained in Western medicine and often dismissive of traditional Indian medicine. They touted their medical supremacy as justification for colonial rule.
Despite their cockiness, the IMS and other health authorities lacked a solid grasp of infectious disease. Many doctors at the time believed that a fatal corruption of the air caused disease (the miasma theory).
A more insidious hypothesis suggested disease was the product of a dirty environment. That those living in unsanitary conditions were poor and non-European was a coincidence. As noted in an 1894 report, the British in India would “never be safe so long as the native population and its towns and villages are left uncleansed to act as a reservoir of dirt and disease.”
In 1896, bubonic plague made its way into Bombay (modern-day Mumbai). In response, the colonial government quickly passed the Epidemic Diseases Act of 1897, giving IMS soldiers and health officials carte blanche. What did they do with their newfound, practically unmitigated power? It went about as well as you’d expect.
Doctors embraced social Darwinism to explain the relationship between humans and disease.
Because diseases like plague were associated with overcrowding and the indigent, Indian families in working-class neighborhoods were forcibly removed from their homes, their possessions burned and floors removed. Anyone with so much as a whiff of fever was isolated, and British officers segregated their relatives in special camps. Hospitals became a source of fear. In his account of the Bombay plague, J.K. Condon wrote:
The people not only regarded hospital treatment with detestation, but reports were freely circulated that the authorities merely took them there to make a speedy end of them.
British soldiers raided homes like it was a military operation. To isolate suspected cases, “natives” were forced to undergo a humiliating examination, in which a “careful exploration” of the unfortunate individual was needed. Doctors and translators didn’t accompany every search party, making the horrific experience all the more terrifying. Soldiers compelled women to leave their homes and subject themselves to “inspection” in the middle of the street. An elderly woman recalled how the men
Felt…the whole of my body and then made me sit and rise and, sitting around me, went on clapping their hands and dancing.
Soldiers ransacked homes, stealing heirlooms and trinkets. They gorged themselves on what little food families had and conducted themselves like they were in a rage room. This behavior was an open secret. Officials acknowledged that Indian households hid sick individuals to “avoid the inconvenience and petty expenses of disinfection, destruction of clothing, etc.”
The colonial government vigorously denied allegations of abuse of power and lawlessness because of course they did. As far as they were concerned, the draconian methods worked. Trade from the Indian subcontinent was damaged but not broken, and there was a sense that plague posed no threat to the West. The strict measures imposed by the British Empire caught the attention of other European powers, who were busy putting out fires of their own.
Europe in the 19th century heavily relied on colonial possessions and was anxious to keep raw materials and goods flowing through its lucrative ports. Civil unrest threatened to cut off supply from overseas territories, which is a drag if you’re an imperialist. As if uprisings weren’t enough, disease outbreaks resulted in embargoes and tariffs, not to mention the death of European settlers and native populations alike.
Beginning in 1851, representatives from across Europe met to discuss the impact of infectious disease on health and bottom lines (gotta get that paper). In 1892, they adopted the first International Sanitary Conventions.
These conventions prioritized European protection and trade. They targeted diseases emerging from colonies and favored the intrusive medical exams introduced by Great Britain in India. As a result, health officials ignored the diseases that festered in their backyard, reinforcing the racist belief that Europeans have a superior immune system. In its rebuke of the city’s handling of the plague outbreak, The San Francisco Call leaned into this xenophobic drivel, writing:
It is the testimony of science and experience that in climates like ours, if indeed there be any other as excellent, the immunity of others than Asiatics is perfect.
The conventions assumed infectious disease, poverty, and poor sanitation were inextricably linked. In some ways, they were onto something; even today, unemployment and low income are associated with a higher risk of infection. Unfortunately, doctors embraced social Darwinism to explain the relationship between humans and disease.
In India, the consensus was that plague spread through contaminated cuts and abrasions on bare feet. As it so happened, plague patients tended to be poor and would go barefoot. Say no more. The Indian Plague Commission took this theory and ran with it. Their heavy-handed approach likely worsened the outbreak by encouraging the actual culprits, rats, to move from one destroyed home to the next and flee sewers pumped with disinfectants.
By tying disease to socioeconomic status, health officials were, knowingly or not, associating it with race. In America, immigrants lived in squalid conditions and worked for meager pay. That overcrowded areas with inadequate sanitation are hotbeds of disease may seem like common sense, but the germ theory of disease wasn’t the scientific orthodoxy it is today. Political attitudes filled the gaps left by science, and upper-class society, already suspicious of immigrants and the downtrodden, now feared them as harborers of infection.
This vilification of the “other” is a recurring theme throughout history:
- During the Black Death, Christians falsely accused Jews of poisoning wells and tortured them until they “confessed.”
- Early Christians found themselves on the receiving end of persecution in the 2nd century. When an outbreak of smallpox rocked the Roman Empire, Roman pagans slaughtered Christians, hoping to put an end to the scourge.
- A plague outbreak in Cape Town, South Africa resulted in the forced removal of the city’s Black African population to a segregated camp, setting the stage for Apartheid.
- In Honolulu, the Board of Health burned buildings in Chinatown to slow the spread of plague, resulting in a fire that blazed for seventeen days and displaced thousands of Asian immigrants.
- AIDS appeared to be very selective of its victims, preying on those whom many considered immoral — gay men, addicts, prostitutes. The disease was seen as divine retribution, a punishment for sinful behavior.
These days, the World Health Organization, which grew out of the International Sanitary Conventions, and public health in general, is more scientifically based and less, well, racist than its predecessors. But despite the better angels of our nature, Eurocentrism retains a firm grasp on international disease management.
History is not on democracy’s side.
President Trump has taken to calling coronavirus the “Chinese virus” while citing disease outbreak as justification for harsh border control policies. The Secretary of State blames the Chinese government for releasing the virus from a lab. Several European countries have closed their borders in pursuit of isolationism. In Italy, Alessandra Mussolini (yes, that Mussolini) refers to the virus as the “Wuhan virus” and trades in conspiracy theories. Researchers have found that as anxiety about the pandemic increases, so does the appeal of nationalist and authoritarian ideals.
Oh, and remember the Epidemic Diseases Act of 1897? Yeah, it’s back. Legal scholars have raised concerns that the law, which is more than a century old, is severely limited in its ability to control an outbreak, and does not contain any provisions that protect the rights of citizens. Prime Minister Narendra Modi, an avowed Hindu nationalist, is a big fan.
Strongmen exploit chaos, using xenophobic dog whistles to rile aggrieved supporters. They leverage social upheaval and ethnic hatred to gain power. When an emergency upends the natural order, lawmakers sidestep established political machinery to pass sweeping reforms. Sometimes this leads to landmark legislation, like the New Deal. But FDR is the exception, not the rule. Crisis paves the way for dictators, and history is not on democracy’s side.
Although knowledge of disease has advanced quickly, the human condition hasn’t budged in millennia. The Trump administration’s overt racism shouldn’t surprise us, but it should frighten us. Jingoism is a hallmark of this presidency, and it’s easy to dismiss the language around coronavirus as just another Trumpism. But we can’t be complacent at a time like this. We’re already seeing just how badly Trump wants to rule like a dictator.
Don’t expect this president to enact any meaningful policy aimed at curtailing the pandemic and improving the lives of those most in need.
Instead, expect more inflammatory rhetoric and chest-thumping.
Expect ongoing racial tension.
We know what this crisis can lead to if we don’t amplify voices of reason and call out nationalism masquerading as science. To be silent is to risk losing more than the countless lives we’ve already lost to this pandemic.