Alex Chase-Levenson’s monograph, The Yellow Flag: Quarantine and the British Mediterranean World, 1780–1860, is a wide-ranging contribution, based on a stunning array of primary and secondary sources. It traverses multiple historiographical fields: the medical history of contagionism and prophylactic practices and the histories of international diplomacy, transnational mobility, and public health policies. It moves deftly between the anthropology of travel, exclusion, and rites of passage and theories of international cooperation in political science, from shipping statistics to Orientalist constructs of the Levant.

Chase-Levenson identifies the late eighteenth century and first half of the nineteenth century as a unique moment in the history of Mediterranean quarantine, during which a system that he calls “universal quarantine” (7) operated in Southern European and British ports. The targets were ships coming from Ottoman territories, invariably subjected to quarantine procedures. Before this period, he argues, Mediterranean quarantine was more haphazard, and not coordinated internationally; after, it was predicated on racial ideas and the singling out of individuals, particularly non-white people, rather than on blanket geographical notions of morbidity. Quarantine practices offer us a lens to understand the early-nineteenth-century European Mediterranean as a unified space, as well as the role of Britain within it.

Chapter 1 surveys the horrific death tolls of European epidemics well into nineteenth-century “modernity.” Together with the “rumors” of foreign epidemics (36–7), and the French Wars’ mobility upheavals, these sanitary crises stimulated new policies of universal quarantine. War, however, also supplied methods of control, priorities, and expertise that were carried over into peacetime quarantine practices. This argument follows the scholarship that has identified military administrative developments as foundational for modern medical structures.

Chapter 2 deals with British policy toward the Mediterranean and its relationship to quarantine regulations. Chase-Levenson takes on those historians who have argued for a characteristic anticontagionist strain in British opinion, stemming from ideologies of liberalism and free trade. Instead, he situates British attitudes and rules in conversation with developments in Mediterranean polities, and the ebb and flow of strategic needs.

Chapters 3 and 4 discuss the key actors in the performance of quarantine: the boards of health, caught between the national and the international and seeking to satisfy the standards of their equivalents abroad, and the travelers themselves, trapped in inhospitable, dull, and scary spaces, according to complex rituals that marked the boundary between cleanness and contamination. Chapter 5 then builds on chapter 3. Thick information exchange among sanitary bodies and consuls spawned a network of cooperation, into which all actors, including Britain, were locked: a “multipolar” system based on “reciprocity” and “retaliation,” or the permanent threat thereof (4, 126–46). In turn, according to Chase-Levenson, this marked the origin of a European “biopolity” (124–5), a unified conceptual space of health, with hard boundaries to the south and east. He frames diplomacy not simply as a matter of high policy, but rather as a daily business carried out by local civil servants, liaising with their foreign equivalents in relative autonomy from central governments. His approach, as it happens, resonates with recent literature on mobility and identification, such as the work of Hilde Greefs and Anne Winter. Much of the chapter deals with Britain’s position within this system, attempting to temper narratives of difference and isolation.

Chapter 6 briefly explores Orientalist constructs painting the Levant and north Africa as plague-ridden spaces, where climate and culture conspired to promote disease. To some European observers, the arbitrariness of disease seemed to match the arbitrariness of despotic rule. Combined with notions of “corruption” and “excess,” supposed Turkish “fatalism” (167–70) also served as an explanation, despite strong evidence of Ottoman anti-plague measures.

Chapter 7 is entirely set in Britain. It discusses the interface between medical and political debates on contagion and quarantine. Cholera, deemed analogue to the plague but unresponsive to quarantine, contributed to bolstering anti-quarantine discourse from the 1830s onward. Quarantine, more generally, was a significant root of modern state involvement in sanitary matters. Here Chase-Levenson presents an extremely important argument: nineteenth-century British public health policy cannot be studied in isolation from its international context. Still, in this chapter, the Mediterranean itself is but a distant echo (as acknowledged on p. 216). Chapter 8 moves even further away, tracing a fascinating series of direct links through which the Mediterranean experience of plague and quarantine, particularly in Malta, affected the British medical response to epidemic outbreaks in India.

Lastly, Chapter 9 explores the end of universal systems of quarantine, placing it in the 1840s and early 1850s rather than in a slow decline over the following decades. Chase-Levenson argues that the diminished incidence of epidemics and the introduction of quarantine practices on the Ottoman side of the Mediterranean led to a relaxation of European barriers and controls, now limited to ships with foul bills of health. Decisional power migrated from local health boards to central, quarantine-averse governments. Most importantly, however, as a result of these developments, the target of quarantine shifted from travelers as a potentially diseased collective to specific racialized individuals.

The book is rich and convincing. But one point remains slightly unclear: why study the Mediterranean world from a British angle? Britain was the prime imperial power in that sea, but a relative outsider and a player among many in this locally grounded story. Chase-Levenson primarily casts The Yellow Flag as intervening in historiographical debates on British attitudes to quarantine. In so doing, however, he somewhat undersells its fantastic offerings: he unearthed an immense wealth of material from Italian, French, Maltese, and Austrian archives. “Britain in the Mediterranean,” which he discards (49), or “Britain and the Mediterranean” might have been a more effective framing than the notion of a “British Mediterranean.”

Key here is the nature of Britain’s presence in this maritime space. Chase-Levenson acknowledges that military quarantine is “largely understudied” (38), but he does not discuss it in depth. Precisely the quarantine of naval ships, however, frequently challenged by British officers (62–3, 84–5, 102, 130), might be a breakdown point for the systems he identifies. Describing the ways in which Britain had to “adapt” to and “accommodate” local customs lays an important emphasis on Mediterranean resistance in the face of supposedly all-trampling empires (49, 64). But on-the-ground encounters may have been marked by greater inequalities and impositions than wider relations let on.

None of the above, anyway, detracts from the value of what this book does: it undermines notions of British exceptionalism (particularly the supposed equation between a freedom-loving people and anticontagionism), and presents a complex and multiway picture of diplomatic and imperial entanglements. It also offers an extraordinarily subtle and learned transnational medical history. This is an excellent example of all that a monograph ought to be.