Cordon sanitaire (medicine)

A ''cordon sanitaire'' (, French for "sanitary cordon") is the restriction of movement of people into or out of a defined geographic area, such as a community, region, or country. The term originally denoted a barrier used to stop the spread of infectious diseases. The term is also often used metaphorically, in English, to refer to attempts to prevent the spread of an ideology deemed unwanted or dangerous, such as the containment policy adopted by George F. Kennan against the Soviet Union (see cordon sanitaire (politics)).

Origin

The term ''cordon sanitaire'' dates to 1821, when the Duke de Richelieu deployed French troops to the border between France and Spain, to prevent yellow fever from spreading into France.

Definition

A ''cordon sanitaire'' is generally created around an area experiencing an epidemic or an outbreak of infectious disease, or along the border between two nations. Once the cordon is established, people from the affected area are no longer allowed to leave or enter it. In the most extreme form, the cordon is not lifted until the infection is extinguished. Traditionally, the line around a ''cordon sanitaire'' was quite physical; a fence or wall was built, armed troops patrolled, and inside, inhabitants were left to battle the affliction without help. In some cases, a "reverse ''cordon sanitaire''" (also known as protective sequestration) may be imposed on healthy communities that are attempting to keep an infection from being introduced. Public health specialists have included ''cordon sanitaire'' along with quarantine and medical isolation as "nonpharmaceutical interventions" designed to prevent the transmission of microbial pathogens through social distancing.

The ''cordon sanitaire'' is not used now in its most extreme historical form. This is partly due to our improved understanding of disease transmission, treatment and prevention. In modern days, its function is more to allow easier identification and control over contagion spreading. For example, in China, in tightly controlled cordons one delegated family member might have been given an exit pass to do daily shopping, while in loosely controlled cordons individuals might be permitted to enter and exit without control (other than a temperature check) through a main entrance, while other entrances are temporarily blocked.

In its more traditional role, the ''cordon'' also remains a useful intervention under conditions in which: 1) the infection is highly virulent (contagious and likely to cause illness); 2) the case fatality rate is very high; 3) treatment is nonexistent or difficult; and 4) there is no vaccine, or other means of immunizing large numbers of people (such as needles or syringes) are lacking. During the COVID-19 pandemic ''cordons sanitaires'' were imposed on geographic regions around the world in an attempt to contain the infection.

16th century

* In 1523, during a plague outbreak in Birgu, the town was cordoned off by guards to prevent the disease from spreading to the rest of Malta.

17th century

* In 1655, ''cordon sanitaire'' was imposed on the town of Żabbar in Malta after a plague outbreak was detected. The disease spread to other settlements and similar restrictive measures were imposed, and the outbreak was successfully contained after causing 20 deaths.
* In May 1666, the English village of Eyam famously imposed a ''cordon sanitaire'' on itself after an outbreak of the bubonic plague in the community. During the next 14 months almost eighty percent of the inhabitants died. A perimeter of stones was laid out surrounding the village and no one passed the boundary in either direction until November 1667, when the pestilence had run its course. Neighbouring communities provided food for Eyam, leaving supplies in designated locations along the boundary cordon and receiving payment in coins "disinfected" by running water or vinegar.

18th century

* During the Great Northern War plague outbreak of 1708–1712, ''cordons sanitaires'' were established around affected towns like Stralsund, Helsingør, and Königsberg; one was also established around the whole Duchy of Prussia and another one between Scania and the Danish isles along the Sound, with Saltholm as the central quarantine station.
* In 1770 the Empress Maria Theresa set up a ''cordon sanitaire'' between Austria and the Ottoman Empire to prevent people and goods infected with plague from crossing the border. Cotton and wool were held in storehouses for weeks, with peasants paid to sleep on the bales and monitored to see if they showed signs of disease. Travelers were quarantined for 21 days under ordinary circumstances and up to 48 days when there was confirmation of plague being active in Ottoman territory. The cordon was maintained until 1871, and there were no major outbreaks of plague in Austrian territory after the ''cordon sanitaire'' was established, whereas the Ottoman Empire continued to suffer frequent epidemics of plague until the mid-19th century.
* During the 1793 Philadelphia yellow fever epidemic, roads and bridges leading to the city were blocked off by soldiers from the local militia to prevent the illness from spreading. This was before the transmission mechanics of yellow fever were well understood.

19th century

* During the 1813–1814 Malta plague epidemic, the main urban settlements of Malta (Valletta, Floriana and the Three Cities) and rural settlements with a high mortality rate (Birkirkara, Qormi, Żebbuġ and later Xagħra) were cordoned off by the military to prevent people from entering or leaving.
* The first actual use of the term ''cordon sanitaire'' was in 1821, when the Duke de Richelieu deployed 30,000 French troops to the border between France and Spain in the Pyrenees Mountains, allegedly in order to prevent yellow fever from spreading from Barcelona into France but in fact mainly to prevent the spread of liberal ideas from constitutional Spain.
* The 1821 yellow fever epidemic ravaged Barcelona and a ''cordon sanitaire'' was set up around the entire city of 150,000 people. Between 18,000 and 20,000 died in four months.
* During the 1830 cholera outbreak in Russia, Moscow was surrounded by a military cordon, most roads leading to the city were dug up to hinder travel, and all but four entrances to the city were sealed.
* During the 1856 yellow fever epidemic a ''cordon sanitaire'' was implemented in several cities in the state of Georgia with moderate success.
* In 1869, Adrien Proust (father of novelist Marcel Proust) proposed the use of an international ''cordon sanitaire'' to control the spread of cholera, which had emerged from India and was threatening Europe and Africa. Proust proposed that all ships bound for Europe from India and Southeast Asia be quarantined at Suez, however his ideas were not generally embraced.
* In 1882, in response to a virulent outbreak of yellow fever in Brownsville, Texas, and in northern Mexico, a ''cordon sanitaire'' was established 180 miles north of the city, terminating at the Rio Grande to the west and the Gulf of Mexico to the east. People traveling north had to remain quarantined at the cordon for 10 days before they were certified disease-free and could proceed.
* In 1888, during a yellow fever epidemic, the city of Jacksonville, Florida, was surrounded by an armed ''cordon sanitaire'' by order of Governor Edward A. Perry.
* In 1899, an outbreak of the plague in Honolulu was managed by a ''cordon sanitaire'' around the Chinatown district. In an attempt to control the infection, a barbed wire perimeter was created and people's belongings and homes were burned.

20th century

* During the San Francisco plague of 1900–1904 San Francisco's Chinatown was subjected to a ''cordon sanitaire''.
* In 1902, Louisiana imposed a ''cordon sanitaire'' to prevent Italian immigrants from disembarking at the port of New Orleans

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