Page of

Preface 

Source:
Oxford Textbook of Infectious Disease Control: A Geographical Analysis from Medieval Quarantine to Global Eradication

This book begins seven centuries ago among the lazarettos of Venice and ends among the saints of Palermo. Both lazarettos and saints in different ways – the first by quarantine and isolation and the second by alleged cure – attempted to control the geographical spread of communicable diseases. Although modern readers will show askance at the notion of saints against disease, saints for and against almost anything were deeply embedded in the life and culture of medieval Europe. And it was in medieval Europe that the first significant attempts at controlling the spread of communicable diseases began. Religion was central and scientific knowledge scant. Against what we now know to be communicable diseases, saints like Rosalia of Palermo (1130–70), who was alleged to have halted the spread of the Plague of Palermo in 1624, were and still are commonly appealed to. There are six cities in Latin America alone named after her. In the twenty-first century, like Rosalia, the world is still working at disease control, eradication and elimination. As this book is being written, in an initiative dubbed the London Declaration on Neglected Tropical Diseases, a coalition of 13 global drugs companies brought together by the Bill and Melinda Gates Foundation aims to provide 1.4 billion treatments annually to eradicate five neglected tropical diseases and to bring a further five under control in the developing world. The World Health Organization’s roadmap to elimination in support of the London Declaration appears in the Preface table.

The geographical control of human communicable diseases is touched on in many books but this is the first systematic monograph devoted to the topic. In six chapters it tackles surveillance, quarantine, vaccination, and forecasting for disease control. In the twenty-first century, with an armoury of early warning and vaccination methods at our disposal, it is easy to forget that, by the middle of the seventeenth century, the states of Italy had already developed a sophisticated spatial system to try to control the spread of plague, a system which involved surveillance, border controls, medical passports for goods and people, quarantine and forecasting. As noted in Cipolla (1976, [link][link]), the concept of health organisation as developed in the renaissance Italian states eventually found systematic expression and elaboration in the late 1770s in the System einer vollständigen Medizinischen Polizey by Johann Peter Frank (1745–1821), volumes 1–4 of which were first published in Mannheim in 1779–88. Volume 5 appeared in Tübingen in 1813, and volume 6 in Vienna in two parts in 1817–19. But the philosophical mood of the times by the end of the eighteenth century favoured the individual, and the state was seen as a centralised oppressor. Plague also disappeared, and with its disappearance, opposition to health controls and regulations became progressively more vociferous. Laissez faire prevailed and when cholera struck The Times observed people “would rather take the risk of cholera and the rest than to be bullied into health”, Italian ideas on control were regarded as obsolete and abandoned until the modern period. Then it took the vision and energy of people like Benjamin Disraeli and Sir John Simon once again to develop the concept and to set up a system of Public Health. There was rediscovery rather than continuity on methods of disease control and this time the British and the French led the way, uncovering once more many of the Italian ideas now used in current disease control systems. And so in Chapter 1 we begin our story of the geographical control of human communicable diseases by describing the elements of the Italian system and their operation as a backcloth to our substantive treatment of infectious disease control in the five chapters which follow.

Infectious diseases spread from person to person and so from place to place. Thus the control of spread has a strong geographical component which, given our own interests and a lifetime working as professional geographers, is central to our consideration of the control problem. We explore the geographical dynamics of control through our selection of diseases and themes which can either be analysed statistically over substantial historical time spans or which can be mapped in specific geographical settings. In each chapter, we have tried to assemble representative maps to illustrate the ideas we explore.

As we have noted elsewhere, for the authors, this book is part of a much larger canvas on which we have been painting for more than a generation. There has been a series of epidemic disease monographs which focus on specific infectious diseases (notably measles, influenza and poliomyelitis), on specific epidemiological sources (the United States consular records of disease), and on specific themes (such as island epidemiology and the role of conflict in epidemic generation), and there have been atlases – on AIDS, disease mapping and epidemics in Britain. As on previous occasions, we have been particularly blessed by the resources made available to us by Tomas Allen at the library and archives of the World Health Organization. These resources were placed at our disposal to complement the great collections on epidemic history in our own university libraries and medical schools. We record with gratitude the contributions of all the skilled staff in these places who have helped us.

Preface table Elimination and eradication of neglected tropical diseases. Target milestones by 2020

Disease

2015

2020

Elimination

Elimination

Eradication

Global

Regional

Country

Eradication

Global

Regional

Country

Rabies

Latin America

South-East Asia and Western Pacific regions

Blinding trachoma

Yes

Yaws

Yes

Leprosy

Yes

Chagas

Transmission by blood transfusion interrupted

Intra-domiciliary transmission interrupted in Americas

Human African trypanosomiasis

In 80% of foci

Yes

Visceral leishmaniasis

Indian subcontinent

Guinea worm

Yes

Lymphatic filariasis

Yes

Onchocerciasis

Latin America

Yemen

Selected African countries

Schistosomiasis

Eastern Mediterranean, Caribbean, Indonesia, Mekong river basin

Americas and Western Pacific regions

Selected African countries

Source: World Health Organization (2012, Table 1a, [link]).

We have also received financial help and generous support in kind. One of us (AC) was fortunate in retirement to be awarded a Leverhulme Trust Emeritus Fellowship which made the Geneva work possible, while the Department of Geography at the University of Cambridge has provided office space and, crucially, cartographic help. Philip Stickler, Head of the Cartographic Unit in the Department, has sustained the authors with his superb maps, graphs and diagrams for several books now, the last five of which have been published by Oxford University Press. At the Press, Nicola Wilson as medical commissioning editor and Viki Mortimer as production editor oversaw the complex task of integrating a large number of illustrations with a brief text. The design team must have wept on more than one occasion with the high image to text ratio.

Manuscript preparation is always an individual affair, and the authors have had a base for several years now at the Bull and Swan in Stamford where we meet regularly to exchange material – generally monthly which, for a time, was as frequently as the inn changed hands! Happily, stability has now returned. Those closest to us have inevitably borne the brunt of our obsession with research, with its periods of pre-occupation from other tasks. We let these pages stand as a token of our thanks to them.

ANDREW CLIFF

MATTHEW SMALLMAN-RAYNOR

Bull and Swan, Stamford

Feast of Santa Rosalia di Palermo, 2012

Front cover figure description: Painted panel, southern Italy (Kingdom of the Two Sicilies) c.1800. This scene shows the main elements of the context in which Italian states developed defences against the plague from the middle of the fourteenth century. The town with watch-towers on the hillside for surveillance, defensive walls penetrated by gates at which travellers and goods arriving would have had to show passports to gain entry, the estuary essential for trade and communication, and the harbour wall in the foreground. The system developed in Italy is described in detail in Chapter 1.

Rear cover figure description: The global eradication of smallpox. Statue erected outside the entrance to the main World Health Organization (WHO) building in Geneva, Switzerland. The bronze and stone statue was unveiled on 17 May 2010 by Dr Margaret Chan, Director-General of the WHO, to commemorate the thirtieth anniversary of the WHO’s declaration of the global eradication of smallpox. The statue depicts four persons, one of whom is a girl who is about to be vaccinated by a health worker with a bifurcated needle. The bifurcated needle was designed to hold freeze dried smallpox vaccine between two prongs, with the vaccine administered by a technique (multiple puncture vaccination) that involved up to 15 insertions delivered in rapid succession in a circle of about 5 mm in diameter. The base of the statue shows the continents, while the plaques surrounding the statue (written in the six official languages of the WHO) state that the eradication of smallpox was made possible through the collaboration of nations.

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