Historical lessons: pox and Covid-19

What lessons for Covid-19 can be learnt from the past? asks Rina Knoeff, Associate Professor at the Faculty of Arts and the Aletta Jacobs School for Public Health, University of Groningen.

Medical history was never more popular. Every day we are flooded with articles in newspapers, blogs and tweets, drawing parallels between the Covid-19 crisis and historical epidemics such as the medieval plague, the Spanish Flu, HIV/AIDS or SARS. Invariably, the question is what historical lessons can be learned for today’s pandemic.

Rarely, however, do we find a well-argued and credible answer to this important question. Dutch media usually point at historical similarities and emphasise the success of past medical interventions. Yet, merely invoking historical parallels does not offer new insights; on their own, parallels only point to what we already know. It is undoubtedly the case that the widespread introduction of hygienic measures during the nineteenth century helped in fighting cholera, diphtheria and other deadly epidemics, but such an historical fact does not help in our battle against Covid-19 now. Hospitals, the medical sector and individual citizens know very well what hygiene is and take the appropriate measures. Soap was among the first items to be sold out in supermarkets, no reminders of the past needed.

The question is what we can really learn from the past. It remains important to think about historical parallels – interventions that were, in principle, comparable to the interventions we are inclined to adopt today. However, instead of focusing on the successful strategies of the past, historians should turn their attention far more often to interventions that have not worked. Those failures give reason to pause, they stimulate our thinking and warn against pitfalls. In all those cases, it is striking how cultural, socio-economic differences and political decisions have been the decisive factor.

Let me illustrate this with an eighteenth-century example. The British physician John Haygarth (1740-1826) famously developed a series of interventions against the epidemic spreading of pox, which – according to Haygarth’s own calculation – caused the death of at least one in six children. His approach and measures were comparable to the measures we are dealing with today:

  • Social distancing: Haygarth had discovered that pox spreads via personal contact within a distance of 46 cm (rather than via the air over long distances). He advised patients to stay inside and to keep away from people who are extra vulnerable to the disease.
  • Cleanliness: Every object or surface that has been in contact with saliva, mucus or other infectious substances needed to be cleaned.
  • Contact tracing: Haygarth traced and followed single infected cases of smallpox in order to map the spreading of the disease.
  • Group immunity: Via a widespread programme of inoculation (in his time, the careful exposure to infected material) Haygarth wanted to reach immunity.

Haygarth was convinced that keeping to these measures would reduce mortality with at least 75%.

With the knowledge (and hope) of today, we might expect Haygarth’s ideas to have been successful. However, nothing is farther from the truth. As the historian Arthur Boylston has argued, Haygarth’s strategies failed on two accounts. First, socio- economic differences proved insurmountable. The poor were not inclined to stay inside and give up their meagre income; the rich were not prepared to follow rules as soon as they had reached a certain level of group immunity. Second, people felt uncomfortable over the loss of individual freedom and felt spied upon by networks of governmental health inspectors.

So, what can we learn from Haygarth’s failure for today’s covid-19 crisis? Of course, we would do well to think carefully about restricting personal freedom for a longer period of time. While we might all be prepared to stay indoors at the moment, who can say if this remains the case when livelihoods are in danger? Or when people on a large scale get confronted with the psychological consequences of solitude? Perhaps much more important is the question of how much our policies take socio-economic differences into account. If you do not have much, it is much harder to follow rules imposed on you. What extra measures are taken to meet the special needs of low-income groups in the problem areas of cities, the needs of homeless people and asylum seekers? How big a disaster will we face if covid-19 remains under the radar among these groups? Haygarth’s failure also sends the dire warning that measures are often taken with a focus on the interests of the economically stronger parts of a society. This might also hold an important warning for the North of our country. It is likely that group immunity will be reached earlier in the economic hotspots in the South and West of the Netherlands. How much determination and solidarity will there be, then, to continue costly measures for the North?


Rina Knoeff is Associate Professor at the Faculty of Arts and the Aletta Jacobs School for Public Health, University of Groningen.

Arthur Boylston, ‘John Haygarth’s 18th-century ‘rules of prevention’ for eradicating smallpox’, in Journal of the Royal Society of Medicine 107:12 (2014) 494-499. https://doi.org/10.1177/0141076814557198

This article was first published (in Dutch and English) on the blog for the Aletta Jacobs School of Public Healthat the University of Groningen.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.