Early Quarantines

Erin Butler (MM Hu)

In this period of frequent self-isolation and quarantine, it is easy to think that we live in unique times. However, this is not the case. Formal systems of quarantine date back 600 years, to the time of the bubonic plague, and isolation dates back even further. The first official quarantine began in 1348 in Italy at the time of the Black Death, with the word quarantine originating from the Italian word quaranta - meaning forty – which was the length in days of this state-imposed isolation.

But what is quarantine? It is a form of restriction used to contain the spread of diseases, which often entails a separation of goods and people who have been exposed to a certain disease.

We commonly use the words isolation and quarantine in connection with each other, but it is important to distinguish between the two. Isolation (in the context of infectious diseases) involves separating the infected and quarantine involves separating those who may have come into contact with infected people. The earliest form of isolation recorded is in the book of Leviticus - in the Bible - where those with leprosy were isolated from society, ‘the priest is to isolate the affected person for seven days.’ Furthermore, in 541 CE the plague of Justinian came about, and the emperor of Justinian set out a series of laws against those he believed responsible for the epidemic, including Jews, Samaritans and homosexuals. Here we can see early discrimination and potential problems stemming from isolation and quarantine. However, this example cannot be regarded as a quarantine, as Justinian had no knowledge of what caused the disease to spread, and anyone who differed from the Christians of Constantinople was accused of being responsible for the plague. He attempted to halt people’s movements, but it was a complete failure. As we know, religion has nothing to do with carrying a plague.

The Bubonic Plague, which had originally started in the far east, reached Europe in the 14th century and was later responsible for the death of 30% of the population. It was caused by the Yersinia pestis, carried by rats predominantly, which spread the Black Death. Due to the detrimental effects of the disease and the 30 million deaths it caused, Italian states came up with strategies to reduce its spread and this is where we find the first official quarantine. This began in 1348, where a council in the republic of Venice gained power to detain ships in the Venetian lagoon for up to 30 days and turn others away. This was important as the plague was carried on rat-infested ships and as Venice was such an exposed city, this had to be monitored. As other ports in Italy, like Florence and Genoa, and those in surrounding coastal cities began to be infected, they too drew up restrictions and laws to help stop the spread of the disease.

In 1377, a decree was drawn up in the Venetian-controlled port, Ragusa, now Dubrovnik, Croatia, establishing a ‘trentino’. This stated that all ships coming from areas of infection or suspected infection must quarantine for 30 days outside of the harbour, while authorities inspected the ship. The law consisted of four parts: citizens from areas of the plague had to isolate for a month, no person could go to the isolated area, no one could bring food unless assigned by the Great Council, and anyone who didn’t follow this could be fined or made to isolate. Ultimately, the time extended to 40 days for reasons much debated, becoming a ‘quarantino’. Some argue it came from Hippocrates’ idea that after 40 days, diseases were no longer acute, but chronic. Other authors suggest that 40 days was selected for biblical reasons, such as the period of Lent or the great flood of Noah. Whatever the reason, the extension to 40 days was beneficial, as scientists have now discovered the lifespan of the bubonic plague was about 37 days.

As well as quarantining ships, Italian states created a quarantine for infected people and their family on land. In Milan and Reggio, victims were left to die in their homes, and a law drawn up in 1374 meant that all those suffering must be taken out of the city into a forest or field, and left to recover or die. A few years later, in 1423, further steps were taken to avoid the spread of disease. In Venice, the first permanent plague hospital was created on the island of Santa Maria of Nazareth, on the Venetian lagoon. This hospital became known as a Lazaretto and so did all the other quarantine centres in Italy created in the years to come. The Lazaretto was commonly referred to as Lazarethum because of the links to Lazarus, a biblical figure and the catholic patron saint of leprosy. Lazarettos were located far enough from settlements to protect the healthy populations, but close

enough to transport the sick immediately to them. They also tended to be separated by a barrier of water, either natural or man-made. Near ports, members of a ship’s crew were transported into the Lazarettos and their goods were brought in to pesthouses to be cleansed by treatments such as continuous ventilation or emersion in water.

During the Renaissance period, the research surrounding infectious diseases developed. The Italian physician Girolamo Fracastoro suggested the idea of contagion and that small particles in the air could transmit disease, making medicine more precise and effective. In this period, certain city states, beginning in Italy, introduced bills of health, and the plague diminished hugely. The bills of health suggested the sanitary reputation of a ship, and those with clean bills were permitted to proceed to their destinations, without having to quarantine. Furthermore, in some areas, armed guards were placed along transit routes and access points to the cities and a sanitary cordon could be imposed, a restriction to a certain geographical area. Boats suspected of carrying the plague were also signalled with flags so authorities could order quarantine for these ships on suspicion of the disease. These methods, which were first used in Italian cities, were later adopted by many other European countries, not only for the plague, but for the many other epidemics that followed, like the one we find ourselves in currently.

In England, the first quarantine regulations were drawn up in 1663, where every ship entering London had to remain at the mouth of the Thames for 40 days, sometimes extended to 80. This was due to the Great Plague of London which killed between 75,000 and 100,000 people in the capital. Later on, the 1710 quarantine act was passed for an outbreak of the plague in the Baltic. When the plague killed about 100,000 people in Marseille, the act was reviewed and a new one considered in 1721. Huge opposition occurred over clauses which involved infected people being detained with violence and attempted escape potentially resulting in death. Consequently, any healthy person who tried to visit could also be detained and an attempt to escape could, again, result in death. Trenches could also be dug to separate healthy from sick. A formal protest of 18 lords tried to repeal the 1721 quarantine act as such clauses were unknown to their free and liberal constitution.

We can immediately see the flaws of quarantine. In England, the majority of the population detested the idea, and it was often disregarded. This meant that regulations had to be even stricter, and we can see a reflection here in our own society. The lack of a clear length of time people were told to quarantine meant that some perceived quarantine as less scientific and thus they became more suspicious of its efficacy. Further measures taken by the government became repressive; for example, using the inspection of ships for political spying and in Moscow in 1664, the death penalty to anyone who entered the country. In early quarantine history, some places prevented minority groups like the Jews and lepers from entering areas and in some states complete social divides arose between the healthy and sick. Diseases and the detainment of the sick has often led to discrimination in societies and a negative stigma surrounds the sick, even after containment. There are also serious economic effects to consider, especially at the time of the Black Death. Sea trade was the main source of income for many countries and so with certain bans, economies were greatly threatened. There is also the idea that certain wealthy families could buy themselves out of quarantine.

I would argue there are still serious problems with quarantine, even though we have developed it. Obviously, there is the idea of human rights and liberty being affected, but this is almost inevitable as the definition of quarantine entails separation. I would argue the problem now is people not taking quarantine seriously. A study in the Harvard School of Public Health showed that before Covid-19, if influenza were to spread through the US, the co-operation of the public would be low. This can be seen in the situation we are in now as people still continue to reject quarantine regulations, such as social distancing and mask wearing. Our society has come to believe that the battle against diseases has been won; however, this is not the case. Although quarantines were less advanced in the past, the fear of disease and the lack of information meant people and governments tended to cooperate, despite resenting the idea. In our society, it is hard for the government to offer death sentences and extreme punishments and so the population is hard to keep under control. I think we still have lots to learn from the history of quarantine and we haven’t yet mastered it.