Abstract
The following comments by the Medical Officer in the 1877 Report of the Local Government Board for England, quoted with approval in Reynolds’s System of Medicine,
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place much of the debate we have heard in the last six months about COVID-19, public health, politics, quarantine, commerce and test-and-trace into historical perspective: Of systemic action adopted in England for the prevention of the importation of infectious diseases, the system of quarantine (in the commonly received sense of that term) performs an extremely small part, if, indeed, it may not be said to be abandoned; an altogether different system, called the system of medical inspection, having for some time past been employed. A quarantine which is ineffective is a mere irrational derangement of commerce; and a quarantine of the kind which ensures success is more easily imagined than realised. Only in proportion as a community lives apart from the great highways and emporia of commerce, or is ready and able to treat its commerce as a subordinate political interest, only in such proportion can quarantine be made effectual for protecting it. In proportion as these circumstances are reversed, it becomes impossible to reduce to practice the paper plausibilities of quarantine. The conditions which have to be fulfilled are conditions of national seclusion.
By the time of World War II, the system of ‘medical inspection’ referred to had evolved into an effective local public health system. My father, a single-handed General Practitioner, was also the Medical Officer of Health for our village of Caerleon in Monmouthshire of approximately 3000 people. He was responsible for the local diagnosis, notification, isolation, treatment or vaccination of the many bacterial or viral outbreaks of that pre-and post- World War II period. At the height of the COVID-19 pandemic in northern Italy, Professor Romagnani was able to protect the village Vo’Euganeo of roughly 3000 people by his prompt policy of testing, tracing and isolation, 2 another example of ‘shoe leather’ epidemiology described by Ashton. 3
A proven system of local public health has been allowed to wither in this country by a combination of complacency and inappropriate predominantly central reorganisation. It is regrettable that a system of quarantine abandoned 140 years ago to preserve commerce should be revived now largely because of the decline of an effective local system of ‘medical inspection’.