American Contagions: Epidemics and the Law from Smallpox to COVID-19

by John Fabian Witt

A concise history of how American law has shaped--and been shaped by--the experience of contagion, taking us from the smallpox outbreaks of the colonies to COVID-19. . . . The conclusion [Witt] arrives at is devastating. --Jennifer Szalai, The New York Times

From yellow fever to smallpox to polio to AIDS to COVID-19, epidemics have prompted Americans to make choices and answer questions about their basic values and their laws. In five concise chapters, historian John Fabian Witt traces the legal history of epidemics, showing how infectious disease has both shaped, and been shaped by, the law. Arguing that throughout American history legal approaches to public health have been liberal for some communities and authoritarian for others, Witt shows us how history's answers to the major questions brought up by previous epidemics help shape our answers today: What is the relationship between individual liberty and the common good? What is the role of the federal government, and what is the role of the states? Will long-standing traditions of government and law give way to the social imperatives of an epidemic? Will we let the inequities of our mixed tradition continue?

Genres: Nonfiction, History, Science, Law, Politics, American History, Health

184 pages, Hardcover

First published August 31, 2020

Reviews

[Chris · Rating 4 out of 5]

A short but dense read on the legal history of epidemics within the U.S. I really took my time with this one. I would give 4.5 stars as he made no mention of the isolation of those with TB or Hansen's Disease (leprosy). The author is a professor of Law and History at Yale University and this was published in OCT 2020, so it just skims the surface of what was happening with COVID and public health policy and interventions. From the back flap blurb "...shows how infectious disease has both shaped and been shaped by the law" It highlights some of the questions people have raised currently such as the tensions between individual liberties and the common good. It answered the questions for me about the role of the federal government vs. states during public health crises.

There are many examples unfortunately of discriminatory policies/interventions throughout our history that continue to this day. How the inequities of the past have been compounded over time and have been illuminated in this current crisis.

No surprise that an academic would have citations and suggestions for further reading that take up 21 pages!

The author's hope is that "people who know their history make better choices". If only that were true!

I. Introduction - starts out with a quote from Cicero translated as "the health of the people is the supreme law." I knew I would find this book to my liking and hopefully interesting and educational, which it was.

The next 2 chapters gave the history of the two prevailing schools of thought regarding how to respond to epidemics: The Sanitationist State and Quarantinism in America

Chap 3. Civil liberties in an Epidemic?

Chap 4. New Sanitationisms/New Quarantinisms

Chap 5. Masked Faces toward the Past

Afterword: Viral Protests.

" America has two histories: one ugly and one far more appealing. In the months and years ahead, Americans will hold the power to choose between them. Let's make the right choice."

Somehow I don't believe that Witt will think the right choices were made by all throughout this pandemic response to date.

[MIKE Watkins Jr. · Rating 5 out of 5]

Wonder why State governments have so much in regards to public health issues (such as how to handle COVID-19)? If so, this is the book for you.

The book starts out by pointing out that early American responses to epidemics exerted considerable state authority and substantially limited individual freedoms in order to achieve public health victories.


Furthermore, this state authority was often exercised against specific groups and communities.

For example, "In March 1900, a suspected death from bubonic plaque in san Francisco led to a immediate lockdown of the city's Chinatown, with an order that no one be permitted to cross the quarantine line expect white people, who were allowed out"

" Throughout the 19th century, authorities mandated risky vaccinations for poor and disenfranchised populations, the "prowling negroes and shabby whites", as a New Orleans sanitary inspector called them in 1877".

It wasn't until Cases like Wong Wang v. Williamson and Jew Ho that discriminatory practices were outlawed.


In the mid 1900s a belief that civil liberties should be prioritized began to take hold. A belief that one could preserve civil liberties and somehow keep people safe.

In fact, "during the SARS coronavirus outbreak in the spring of 2003. The DOH concluded that quarantine was "optimally performed on a voluntary basis".



And then COVID came along where the federal government responded by exercises little power ...so State governors decided to fill the vacuum by relying on the Publican health power that the early American jurisprudence of hygiene supplied (that I mentioned earlier).

So yeah it turns out that States have the authority to resolve a health crisis as they seem fit...as long as whatever they are attempting to implement isn't arbitrary or racially motivated

[Isabelle reads a book a day because she has no friends · Rating 3 out of 5]

3.5 stars

[Yaaresse · Rating 4 out of 5]

Interesting overview of how US public health laws and actions (or non-actions) in times of contagious disease outbreaks. Starting with the colonies, Witt moves forward through time and describes various health threats, the measures taken by local and state health departments and/or state and federal governments to try to safeguard the public health. Naturally, the public hasn't always appreciated their efforts, and Witt outlines the many court cases that followed many such measures. There's always a loud and toxic segment of society that prefers to scream about their alleged rights while ignoring that those rights come with responsibilities. The only thing new about Covidiots is the name and the fact that it's only been in the last 20 years or so that anyone cared what they wanted. Historically, public health departments enforced -- and courts backed -- quarantines, mask mandates, vaccinations, etc. Oh, and anti-maskers aren't new either. Apparently groups of "it's all about me" maskholes pop have popped up several times since the 1800s; it's just that local governments and health departments had the balls to slap them with fines in previous times. (And if the masks didn't work that well in 1918, it probably was because they didn't know any better than to make the things of thin gauze.)

Witt also notes all the times in US history that those in power often scapegoated the poor, immigrants, people of color, and other non-WASP folks by both accusing them of causing such outbreaks as cholera, TB, HIV/AIDS, etc. and by denying them equal access to both preventative or treatment resources and actively spreading false information about them in spite of obvious evidence to the contrary. (No doubt Black people would be glad to be immune to cholera, but the number of deaths of African Americans from cholera deny that myth.)

There's not a huge amount of detail in this slim book, but the author cites sources and cases, so it's easy enough to look up any specific cases or laws of interest.

[John · Rating 5 out of 5]

Ann: Okay, Boomer.

This is a fantastic and timely book. It introduces the history and legal debates surrounding public health and epidemics in the US, many of which are relevant today.

Scientifically-accurate, apolitical, and nuanced, Witt faithfully represents and fairly treats the disputants on all sides whose cases related to public health, civil liberties, and state power created the system and circumstances we have today.

It is hardly surprising that politically extreme boomers and vaccine denialists tend to find this treatment upsetting as it doesn't validate their reflexive conspiracism or preferred flavor of science denial.

Ironically, most of the civil libertarians who opposed and contested the expansion of police powers described in this book were liberal left, not Americans on the conservative right, who today try to proclaim matters of science and medicine as questions solely of personal liberty, as if each man were an island. As Witt tells us the Massachusetts Sanitary Commission wrote in 1850: "Every person has a direct or indirect interest in every other person. We are social beings bound together by indissoluble ties..." with a duty "to protect one set of human beings from being the victims of disease and death through the selfish cupidity of others." This is the liberalism Boomers like Ann erroneously equate with the Democratic Party for some reason. It would be silly if it weren't so dangerously selfish in a world ruled by microbes.

I say all of this as an immunologist and writer myself. Ignore the scientific illiterates here saying this book isn't science-based. They clearly expected a text that would flatter their preexisting beliefs and reinforce their preferred political narrative. This isn't it. And good thing too.

[Ann · Rating 3 out of 5]

This book was definitely written from a liberal viewpoint. If you are thinking there will be anything from a scientific or medical viewpoint, you will be disappointed.

[Sara · Rating 4 out of 5]

Reads like an expanded law review article converted for the public. Interesting history and some legal frameworks. I would have liked more legal analysis.

[René Rio · Rating 3 out of 5]

Informative, but bone-dry.

[Broken Lifeboat · Rating 5 out of 5]

This is a great - short but dense - history of public health policy in America. American Contagions gives the history of America's quarantine and sanitation approaches. Fascinating reading about the country's unending struggle between recognizing individual rights against the responsibility of the government in terms of public health.

I appreciate how the author recognizes that public health policy in the United States is inextricably linked to racism and discrimination of vulnerable minority populations. It also cites other social determinants, like livable wages, as part of health policy and often a key reason why disease impacts different areas and peoples.

Published during the first year of the COVID-19 pandemic, it ends hoping that America will choose a progressive path, one that addresses inequality and injustice within the public health emergency.

[Reagan Faith Waggoner · Rating 4 out of 5]

Solid introduction to the history of quarantines, required vaccinations, and other disease measures in the United States. Short and easy to read. Real question is why COVID transitioned so much power to the CDC when historically it has been a power of the states… including the questionable nature of Trump’s measures against early-stage COVID implemented nationally when it theoretically should be a police power as shown by history

[Gabriel · Rating 4 out of 5]

Great brief analysis about how the U.S. has managed epidemics historically, specially from the legal point of view. I liked the explanation and distinction between Sanitationism and Quarantinism.

[Katie ratherbereadinggg · Rating 4 out of 5]

4 stars

[Kathleen (itpdx) · Rating 3 out of 5]

An interesting look at Public Health and the law in the US. Here are some of the things that I learned that are helping me think about Covid-19.
The Constitution puts “police” powers in the hands of states. So although much of the current expertise resides in the Federal government, it is generally up to the states to promulgate the rules and enforce them. The courts both at the state and federal level have acknowledged that power but have also said that the rules have to be logical and non discriminatory. (Not that it has always worked out that way.)
Over centuries there have been two general paths to protecting the public health. One the author designates “sanitarinism” which includes things like building codes, inoculations, education, providing good sewage, garbage collection and safe drinking water. The other path he calls “quarantinism” which leans on isolation and punishment. He indicates that Covid-19 has caused this debate to re-ignite along with debates over individual rights vs. the health of all.
The book also discusses the divides that epidemics highlight along racial/ethnic and wealth lines.

[Coleen Dailey · Rating 5 out of 5]

What an interesting read! A brief history of the government's ability (federal, state and local) to regulate for the general health and welfare of the people of this country. The introduction starts with a description of the police power - the power to regulate for the health and welfare not police criminals and continues with how it has been handled from the beginning settlement of this country until now. The subtitle is Epidemics and the Law from Smallpox to Covid-19. At only 141 pages plus footnotes and suggested reads, it provides a general overview of how we have handled these things. An interesting read in this time in particular.

[Garrick Anderson · Rating 1 out of 5]

This book is not a thorough history of epidemics through American history and their legal responses . It does have a number of examples, but nothing comprehensive, and I really couldn't tell you what the historical moral here was. Here's one passage from the book that summarizes the history of judicial responses to epidemics: "Different circumstances warranted different actions, but the principles were essentially the same: courts would allow sensible public health policies to go forward, but they would retain the authority to intervene to block policies policies that seemed arbitrary or irrational." This is as close to saying nothing as a thesis statement can do.

What it's really about is racism, and argues epidemics expose the racist attitudes of the time. But it doesn't note any special power of epidemics over anything else, which can just as easily expose racist attitudes of the time, and did. In the end, all you get out of the book is that the legal responses to epidemics through history simply reflected the cultural values of the period. But what doesn't?

[Alison · Rating 3 out of 5]

Interesting historical/legal survey. Quick read, but I had hoped for more substantive analysis.

[Noelle Huhn · Rating 5 out of 5]

An interesting take on personal liberties in a pandemic and non pandemic context. What it means to protect others and personal autonomy

[Richard Lester · Rating 4 out of 5]

Good Overview of How American Law Has Shaped Our Response to Epidemics

Good, readable, concise overview of how American law and federalism has shaped the American response to epidemic diseases, including Covid-19. Witt explains complicated court cases and legal doctrines clearly, in a way which is accessible to the general reader, who does not have specialized legal knowledge. He illuminates historical patterns in how the United States has responded to epidemics and pandemics. In particular, Witt explains how and why the United States has tended to rely more heavily on state and local governments, rather than the federal government, to respond to epidemics, a pattern quite notable in our response to Covid. Witt also analyzes how recent Supreme Court decisions narrowing the Court's interpretation of the Commerce Clause may have constrained the federal government's ability to respond to pandemics. I would recommend the book to anyone seeking an overview of the American response to epidemics in historical perspective.

If the book has any flaws, it is that, as a broad overview of the history of American responses to epidemics, it sometimes is unable to discuss individual topics in as much depth as the reader would like. Also, I thought Witt could have defined the term "quarantinism" and the distinction between "quarantinism" and "sanitationism" a bit more clearly. By "quarantinism", Witt clearly means more than just the imposition of quarantines. But it's not always clear exactly what the term encompasses. Witt associates " quarantinism" with discrimination and racial disparities in health care. It's true that, historically, quarantines have often been applied in a racially discriminatory manner. But are quarantines inherently always going to be discriminatory? Probably not. I also thought Witt could have developed his analysis of mass incarceration as leading to a new form of "quarantinism" more fully. And, while I appreciated Witt's concern with balancing public health measures and civil liberties, I thought Witt could have given more attention to how the greater transmissibility of Covid, compared to HIV, changes the appropriate balance between mandates and voluntarism. Also, the book clearly was written during the early days of the Covid pandemic and unavoidably cannot discuss some of the legal and political issues which have emerged more recently. Given the rapidity of events, it may be time for a revised edition already.

[Andrew Figueiredo · Rating 4 out of 5]

John Witt has put together a readable but information-packed discussion about public health law and disease in American history. He identifies two strains of policy--quarantinist and sanitationist. The former is more based on coercion, isolation, and mandates while the latter stresses improvement of social conditions, voluntary compliance, and greater respect for civil liberties. Over the years, courts strove for a balance between the two approaches, generally respecting the government's prerogative to act while finding specific abuses out of line. Quarantinist approaches were especially deployed against working-class and minority communities while sanitationist ones were more often used for elites. Witt identifies a shift that emerged with AIDS and later appeared during the 2014 Ebola scare; civil liberties were increasingly seen as amicable with a sanitationist approach. However, technological surveillance, the nature of COVID-19, and how it interacts with longstanding prejudices threatens to undermine this entente.

While Witt provides strong support for his arguments, the distinction between sanitationist and quarantinist approaches is not always clear. Perhaps it can't be, but Witt doesn't admit that either and tries too hard to create a dichotomy. Moreover, with regard to COVID-19, Witt ignores some of the inconvenient facts, like religious liberty concerns actually being important, school closures more negatively impacting POC, and the way mask mandates (effective as they may have been pre-vaccine) definitely seem more quarantinist. His argument fed a more one-sided political narrative on COVID, but the book's historical look was instructive and provided an applicable framework for evaluating public health law.

[Doug Ward · Rating 4 out of 5]

In the United States, protecting public health has always been the responsibility of state and local governments. This book surveys how states and cities have dealt with epidemics throughout American history, providing some historical perspective on the current epidemic.

The author identifies two broad approaches to dealing with epidemics. The sanitationist approach aims to promote public health by making conditions better for everyone. The quarantinist approach imposes strict regulations, often disciminating against immigrants and the poor in the process. Both approaches have been present side-by-side since the founding of the U.S.

The courts have tended to uphold the power of state and local governments to do what they feel they need to do to deal with an epidemic, including things like requiring vaccinations. One thing that has been different about the current epidemic is that Americans are sharply divided along party lines on how best to handle it.

[Karen · Rating 4 out of 5]

I enjoyed this book immensely. It is very up to date, and I definitely would require students in public health and epidemiology to read this book. With the huge fiasco going on concerning requiring people to get vaccines, this is very necessary information concerning when there have been epidemics and pandemics in the US, have legal means been used to require vaccinations? Yes, in the past its been used. This is not new, what is new is the ridiculous idea that you can live in a vacuum during a pandemic, and not be required to follow the law. People did complain during the 1918 influenza outbreak, but not to the extent the uneducated are doing it now. Witt demonstrates how requirements for vaccines have been handled in the past. This is a bit dry in reading, but I got through it quickly because it is so pertinent to what is currently happening. IF people have questions, just send them to this book!

[Barbara · Rating 4 out of 5]

This small tome summarizes the conflicting attitudes over the centuries between "quarantinism" and "sanitarianism" in the approach to epidemics. I found it an enlightening read. Only toward the latter part of the book is Covid-19 discussed, although it informs the entire book. Our ambivalence in this country toward federal power and what constitutes our individual rights vs our duty toward the common good, has made our response to the pandemic fractured and complicated...and fatal. It made me feel that, even when we do recover from this, that we will not be any more prepared down the line. And, in fact, we may be less so. It is an enlightening read that will help readers to clarify what is going on (or not going on.)

[Michael · Rating 4 out of 5]

I am very glad I read this book. This book provides a very quick, but essential guide, to understanding the variety of responses both from citizenry and government and the responses of the law - in epidemics down through the nation’s history. It sure puts today’s actions and choices in context! It shows how the variety of actions that there are today are very similar if not identical to responses in the past. Though it seems the way we have treated prisoners today is worse than we have treated them in the past. The other thing is that we have not gotten better in xenophobic responses to people we want to blame. I am glad I read it.

[Lydia Chung · Rating 4 out of 5]

An interesting read that anyone who enjoyed APUSH would like. It's full of facts, well organized, and covers a lot of history. There is a lot of focus on discrimination (on the basis of race, social class, and sexuality) with some outrageous cases of bias as well as a focus on balancing civil liberties with the need to protect communities. The exploration of the recent COVID-19 pandemic covers both things that most people who lived through it would know and less publicized pieces about the prison system, something that was actually handled more poorly this time around than it was in past epidemics.

[Adrián López · Rating 4 out of 5]

peoples whining and moaning about comparatively lax and brief public health policies implemented during COVID makes far less sense to me now, even more so than when I started the book. like are you aware the state at one point could just disappear you to the equivalent of a leper colony for so much as a sneeze in the wrong city at the wrong time?

pretty interesting how the states used their immense police powers pretty liberally for most of our history (including/especially during the colonial period!) in the name of maintaining public health. mixed bag of success/failure but not for lack of trying when it came to disease containment

a solid read!

[Ronan Conroy · Rating 5 out of 5]

Are lockdowns an infringement upon the rights of the individual and an assault upon sacred liberty? Are mask mandates unconstitutional and illegal? Not really. In fact, not really at all.
John Fabian Witt lays out a careful and thorough review of the history of how laws and epidemics have been shaped by each other and have shaped each other throughout American history, in this very concise and easy to read little book. In the process, he demonstrates pretty easily that the loudest angriest voices out there crowing on about liberty and freedom are in fact poorly informed as regards the actual legal precedent on these issues. Shocker.

[Cole Butler · Rating 3 out of 5]

Details the history of the legal side of American contagion and how this has culminated in our response to COVID-19. The book was published in 2020, making its commentary on the latter rather slim. Could have been worth additional detail in some places, especially given the subject (my edition is 141 pages with double spacing and small pages). The author makes clear his opinion in some places, detracting from the message. Insightful snippets in some places but disappointingly brief.

[J. Carmona Fuller · Rating 3 out of 5]

Historical and informative. This was an assigned reading for a Criminal Justice course that covers Law and Culture. The material is easy to understand and follow. It seems as though the author presents a great case on U.S. Health policies but leaves the reader asking, "If after some of the government's failed enactments why should the U.S. population believe the government will get it right this time/century?"

[Lisa Furkins · Rating 4 out of 5]

Very informative read although it could have been much deeper - I guess that would have made it a full fledged textbook. I would indeed study Public Health if I was going to pursue a degree today. And, I don't think we've (the United States) have learned anything regarding epidemics or pandemics. And, the CDC is basically useless, in my opinion.

[brian · Rating 3 out of 5]

Ok for the price

This book is a good stepping stone introduction to more in-depth scholarly works. It reads more like a high school paper than a serious review of health policy, and fails to consider many factors involved with ethnic disparities in disease contraction and spread. However, for the price, I am satisfied.