For well over a millennium, public institutions have sought to limit the spread of disease. This article claims that shared political narratives about collective solidarity and belonging expressed in ideas about citizenship shape and constrain public health interventions. While a Sanitarian medical paradigm fit the mid-nineteenth-century British citizenship regime better than one based on limiting contagion by quarantine, full implementation of the “sanitary idea” had to wait upon adjustments after 1870 in the predominantly liberal citizenship regime, and particularly in the (...) institutions of governance and ideas about the responsibility mix. (shrink)