Moving the Dead: From Churchyards to Cemeteries

When we visit old churches in Europe and the Americas, say older than the mid-19th century, we expect to find graves in the churchyards and in the churches themselves, under the floors, in crypts, in the walls. The two medieval parish churches below are an example. The first is in Eyam, Derbyshire, the other in Beddington, South London.

In the Crypt Café in St. Martin in the Fields, London, you can walk and even dance to jazz on the graves of the dead. None of them have gotten up to join the fun, as far as I know. 

Modern churches seldom host the dead, or not very many. Instead, we find them in large cemeteries, usually well away from the old centers of towns and cities.

Why is this? In part, the shift occurred to the rapid growth of population, especially in urban areas. During the industrial revolution, urban populations grew exponentially. New cities mushroomed where once there were mere villages or small towns. Many old cities expanded enormously. London grew from about 600,000 in 1700 to over 4 million by 1900.      

Another development that promoted the change in burial practices was increasing acceptance of the miasma theory of disease. This was the idea that disease spread through bad air, or unpleasant smelling miasmas. 

The main source of miasmas was said to be decomposing organic matter. Swamp and marshes were a major source of bad air (Italian: mal'aria) and many doctors attributed fevers to the gases that arose from them. The bad air theory survives in our name for an ancient disease that remains a major killer, malaria. It is one of the quintessential "miasmatic" diseases. 

Miasmas were blamed for numerous other killer diseases, including typhoid, yellow fever, and one that terrorized 19th century cities: cholera. The color lithograph below, by Robert Seymour (1831), imagines cholera as a death-bearing ghostly cloud.

In the case of cholera and many other infectious diseases of urban areas, the major source of miasmas was believed to human and animal wastes. Disposal of organic wastes became a bigger problem as population densities grew. And they far faster than effective sanitary infrastructures. As historian Stephen Marcus wrote of 1840s Manchester, "people were literally living in shit." 

Miasma theory contributed to demands for urban sanitary reform. Although they knew nothing of the role of germs, advocates of the theory campaigned for the cleaning up of noxious streets and privies, removal of human wastes through sewage systems, and the provision of clean water to houses. 

They also targeted something else: churchyard burials. The growth of urban populations outstripped the burial space in the church cemeteries. As they became more crowded, churchyards overflowed with bodies whose decomposition often produced foul smells, especially during major epidemics. 

The solution, Miasmatists believed, was to ban church burials and create large, parklike cemeteries on the outskirts of towns, away from densely populated areas. The idea produced a lot of opposition from people who believed that burial near the church placed them closer to God. In the end, however, the sanitary reformers won the debate. For good or evil, cities relocated the dead and altered the urban environment in a significant way. 

Below are a few examples of early ex-urban cemeteries:

Highgate Cemetery, North London

Putney Vale Cemetery, Southwest London

Magnolia Cemetery, Charleston, South Carolina

    


 

Yellow Fever and Quarantine in Charleston, South Carolina

During the Covid pandemic, countries, states, localities faced a stark choice: should they restrict human interaction by restricting commercial activity and risk harming the economy? Or should they allow businesses to continue to operate as normal, thus endangering people's lives?

In cities heavily reliant on commerce, epidemic diseases have long posed an agonising dilemma. Closing a city to trade through strict quarantine threatens people’s livelihoods. Leaving it open, even partially open, threatens their lives. As was the case with Covid, both options had their advocates and opponents. 

Charleston, South Carolina, provides an instructive case study of this dilemma. From its foundation in 1670, this southern port was dependent on global trade. At the time of the American War for Independence in the 1770s, South Carolina was the richest of the thirteen colonies. Its wealth derived mainly from exports of rice, indigo, and after 1800, cotton. All of these crops were grown on plantations worked by thousands of enslaved Africans. The reliance on this labour source required regular imports of human cargo. [Image: Charleston Harbor, early 19th century]

As a commercial port, Charleston received unwelcome imports of another sort: diseases from Europe, from Africa, from the Caribbean, and other North American colonies. Some of these imported diseases were highly contagious and deadly, notably smallpox. One, cholera, was transmitted mainly through contaminated water. But nasty as it was, cholera did not arrive until the 1830s and was only an occasional visitor thereafter.

Other imported diseases were transmitted by insect vectors, particularly mosquitoes. The most important were malaria and yellow fever. At least two types of malaria were imported: vivax malaria from Europe and the deadlier falciparum malaria from Africa. Malaria became endemic in South Carolina from the early days of the colony. It flared up every summer and lasted into the late autumn or early winter. Malaria was generally a greater problem in the countryside than in Charleston, especially after about 1750.

Unlike malaria, smallpox and yellow fever were epidemic diseases. They were not an annual problem, but when outbreaks occurred, they could produce widespread terror and high mortality rates. Until the early 19^th century and railroads, yellow fever was largely confined to Charleston and other coastal ports because its vector, the Aedes Aegypti mosquito is a poor flier. Smallpox, by contrast spread widely into the countryside, wherever infected humans travelled. But it came less often than yellow fever.

How to prevent or minimize the effects of epidemics was always a contentious issue for the city’s leaders. It was complicated in the case of yellow fever by difficulties of diagnosis and conflicting views of how it spread. One view was that it spread through the air, through miasmas, or bad air. Another was that it was contagious, passing from person to person. Neither view was correct. The role of mosquitoes in transmitting yellow fever was not established until 1900.

Miasmatists and contagionists differed over the best way to limit the spread of yellow fever. Miasmatists generally believed that disease-causing bad air was generated locally. Closing the port would do little to control the fever, they insisted. Contagionists viewed yellow fever as imported, mainly from Africa or the Caribbean. The best way to control it, they argued, was through quarantine measures. Ships coming from places where yellow fever was common or known to be present should be inspected by physicians. If found to be harbouring the disease, the ships should be ordered into quarantine. Crew and passengers should remain on the ships just outside the harbour or be removed to the pest house or quarantine station until they were no longer considered a danger. 

South Carolina erected the first of several pest houses on nearby Sullivan’s Island around 1707. Quarantine measures were the dominant way of controlling yellow fever, smallpox, and other epidemic diseases in the 18^th century. They were supported by most doctors.

Opposition to quarantine measures for yellow fever increased markedly after 1800. The change was undoubtedly connected to economic decline in South Carolina and Charleston’s sagging importance as a trading port. Interruptions of commerce became a more serious problem than they were in the 18^th century. Acknowledgement that yellow fever was present in a port could greatly reduce its seaborne trade and sharply curtail visitors and potential immigrants.  

Merchants, city leaders, and most doctors in Charleston became increasingly reluctant to declare the presence of yellow fever. They would first deny that a problem existed. When the problem became obvious, they denied that the disease was yellow fever but rather something less dangerous. When forced to concede that yellow fever was epidemic, they argued that quarantine measures would be ineffective, because the disease was generated locally through bad air.

The solution, these Miasmatists believed, lay in sanitary improvements. Eliminating sources of bad odours, cleaning the streets, removing organic wastes and offal, and providing clean water. These measures could have improved health in other ways, but they would have done little to stem yellow fever. 

In any case the city’s sanitary condition did not improve much before the early 20^th century, when yellow fever had already ceased to be a problem. One reason is that sanitary improvement was expensive and often collided with personal and property rights.

A miasmatic explanation of yellow fever, combined with attempts to deny the presence of the disease, had a clear economic advantage. It reduced disruptions to seaborne commerce. Imposition of quarantine measures was delayed, limited, or altogether avoided. 

The fact that most of the victims of yellow fever were “strangers” -- visitors and immigrants, mainly Irish and German – may have made that choice more palatable. It also reduced the number of immigrants, which some locals did not much mind. Charleston's reputation as a yellow fever hotspot for foreigners is one reason why it did not receive as many immigrants as New York, Boston, and Philadelphia.

In 1840, Dr Benjamin Strobel of Charleston wrote a highly controversial essay on yellow fever. He accused commercial interests, boards of health, and the medical establishment, of endangering human lives. Worse, he charged them with "exploiting public ignorance" to rouse opposition to quarantine. The very people who would benefit from a strict quarantine were among its most vociferous opponents. [Image: Benjamin Strobel, 1803-1849]

Strobel demonstrated that yellow fever usually broke out and was heavily concentrated in areas of Charleston closest to the wharves and where sailors and immigrants lodged on arrival. He avoided the thorny issue of contagion. Instead, he argued that yellow fever was somehow transmissible. And he was sure it had been transmitted to the city from ships. He was ostracized for his efforts and left town.

In the 1850s, several lethal epidemics coincided with the opening of a steamship link with Havana, Cuba, a port notorious for endemic yellow fever. In the wake of these outbreaks, support for quarantine measures grew, with a Citadel science professor, William Hume, leading the charge. Hume had been an advocate of miasma theory, but his research convinced him that yellow fever was imported, mainly from the Caribbean. His ideas did not receive a warm welcome either. 

Yellow fever was absent from Charleston during the Civil War. Probably not coincidentally, thanks to the Union blockade, so was most seaborne trade. The last documented epidemic in the city occurred in 1877. How much the retreat of yellow fever owed to stricter quarantine is difficult to say. The decline of the port’s seaborne trade after the war may have been more important. Yellow fever continued to strike busier southern ports hard, notably New Orleans, which suffered the last epidemic in North America in 1905, and the region around Memphis, scene of the worst epidemic in the USA, in 1877. 

Yellow fever in the 19^th century South, as Margaret Humphreys has stated, “was above all, a commercial problem.” And sometimes, local authorities chose the health of commerce, as they saw it, over the health of the people. 

Further reading:

Peter McCandless, Slavery, Disease, and Suffering in the Southern Lowcountry (New York: Cambridge University Press, 2011)

Margaret Humphreys, Yellow Fever and the South (Baltimore and London: Johns Hopkins University Press, 1992)







  

Coronavirus, Quarantine, and Contagion: A Historical Perspective

The spread of Covid-19, or coronavirus, has led many countries and localities to resort to quarantine as a mechanism to contain this new disease. Medical isolation, as quarantine is often called today, has a long history, and its use owes little to modern medical science. 

Examples of isolation of the sick can be found in the Bible, in the Islamic World from the 7th century, and in medieval Europe. Interestingly, most of the quarantine measures currently being used to contain or delay the spread of coronavirus have been used for centuries or longer.

The practice of isolating people with diseases in the past, as today, was based on the belief that the sick were contagious: that they could infect the healthy. That was correct for some diseases, but not others. Even among those that were contagious, some were much less contagious than others. For this reason, contagion theory was controversial until the role of microbes in many diseases was firmly established in the late 19th century. Before then, contagionists could seldom demonstrate how diseases could be transmitted from person to person (or animal to animal).

Diseases transmitted by mosquitoes, like yellow fever, or by contaminated water, like cholera, complicated things for contagion theory. Opponents of contagionism pointed out that people in close contact with the ill often remained healthy, while people who had no such contact contracted yellow fever or cholera.

Contagionism's main competitor until the establishment of germ theory was the miasmatic theory. Miasmatists believed that most diseases were conveyed in the air, through miasmas, or "bad air" ("mal aria" in Italian). Marshes and swamps were considered to be major sources of miasmas, as was rotting organic matter, including human and animal wastes. In the late 18th and 19th centuries, the miasma theory gained many adherents, partly because the growing, unsanitary, and often polluted urban areas produced powerful, obnoxious odors. The miasma theory was wrong but it often led to draining of marshes and the implementation of sanitary reforms that reduced disease mortality.

In the 19th century, however, many traders used miasma theory to oppose quarantine, which could literally shut down ports for weeks or months. They argued that the source of the disease was not incoming ships or people, but miasmas generated locally by unsanitary conditions. 

As is the case today, a concern for health competed with a concern for the economy. As Benjamin Strobel, a Charleston, South Carolina doctor, wrote in 1840: "Truth and justice have been too often sacrificed to expediency and policy, and never more so than in reference to yellow fever. Has it not occurred, when the disease actually invaded us, that there were men who, regardless of the lives of others, and listening only to the sordid suggestions of avarice, have endeavored to conceal the fact?" (Benjamin B. Strobel, An Essay on the Subject of Yellow Fever, Intended to Prove its Transmissibility, Charleston, 1840, p. 9).

The term "quarantine" derives from the Italian phrase, quaranta giorni, meaning forty days. From the time of the Black Death in the 1340s, the Italian city-states took the lead in what we would call public health. 

During plague epidemics, 15th century Venice began to enforce forty days' isolation on ships entering the port. Passengers and crew could not disembark until that period had ended with no cases appearing. Passengers stranded on cruise ships where coronavirus has broken out will understand what a terrible prospect that was. And modern cruise ships are far more comfortable and clean than ships of the past.

Other ports imitated Venice, and quarantine was later applied to other diseases such as smallpox, yellow fever, and cholera (from the 1830s). The length of quarantine then and since has varied, and is usually shorter than 40 days.

From the 15th century on, many ports created quarantine stations for isolation. These were sometimes on ships, on islands in or near the harbor, or on the mainland at a distance from highly populated areas. Some were old leper hospitals, often know as lazar houses, after the biblical parable of the beggar Lazarus. The stations established to quarantine for plague were often called lazarettos or pest houses -- "pest" coming from the French for plague, la peste. Venice established the first lazaretto in 1403 on one of the nearby islands. (Below: one of Venice's lazarettos and that in Ancona, also in Italy).

The oldest surviving quarantine station in the United States dates from 1799. and is near Philadelphia (below). American ports began establishing pest houses about a century earlier.

Inland localities have often used a cordon sanitaire to restrict movement of people in and out of a town or region, where an epidemic was underway. The authorities close off the access points to and from the place to prevent infected people from spreading the disease. In effect, the whole population inside the cordon was quarantined.

Sanitary cordons were a common measure used to prevent the spread of cholera in the 19th century, and are being used again to curb or slow the spread of the coronavirus. China has used them in the city of Wuhan and Province of Hubei during the current coronavirus outbreak. Italy has cordoned off some towns in the North ("lockdown"), then the North as a whole, and now the entire country.

In most cases where a cordon sanitaire has been used, communities have been isolated against their will. But in at least one famous case, in 1665, the inhabitants of a village agreed to cordon themselves off to protect neighboring towns and villages. In that case, the disease was plague. The village was Eyam in Derbyshire, England. The isolation lasted more than a year and killed at least 260 people, possibly more than half the residents who remained. But the disease did not spread beyond the parish boundaries.

During major epidemics, public facilities for quarantining and caring for the infected often became overwhelmed. Authorities often commandeered private houses or other buildings as temporary pest houses or hospitals for the specific disease, such as plague, smallpox, yellow fever, etc. The image below is of a pest house and plague pit in London's Finsbury Fields. The image dates from 1865 but depicts an earlier period, probably the Great Plague of London in 1665. The plague pit next to the pest house can hardly have been reassuring, but the case mortality rate from plague ranged from about 60-90 percent.

Today, many countries are trying to combat the spread of coronavirus by urging people who think they may be infected or are especially vulnerable, to self-isolate at home. Authorities did the same in earlier times, especially during plague epidemics from the 14th century. The isolation was seldom voluntary. Families were often forcibly shut up when one or more became infected. This could be a death sentence for all of them. Daniel Defoe provides a harrowing description of their suffering in A Journal of the Plague Year (1721), a fictionalized account of the Great Plague of London in 1665.

In conclusion, most of the quarantine measures used today have historical parallels. Just as in the past, quarantine may prove more successful in some places than others. We may have the advantage of a better understanding than our ancestors of how many contagious diseases spread, but in the case of coronavirus, we are battling a microbe that is new and somewhat mysterious.