Almost 700 years ago, the overwhelmed physicians and health officials fighting a devastating outbreak of bubonic plague
in medieval Italy had no notion of viruses or bacteria, but they
understood enough about the Black Death to implement some of the world’s
first anti-contagion measures.
Starting in 1348, soon after the
plague arrived in cities like Venice and Milan, city officials put
emergency public health measures in place that foreshadowed today’s best
practices of social distancing and disinfecting surfaces.
“They
knew that you had to be very careful with goods that are being traded,
because the disease could be spread on objects and surfaces, and that
you tried your best to limit person-to-person contact,” says Jane
Stevens Crawshaw, a senior lecturer in early modern European history at
Oxford Brookes University.
A 14th-century Italian fresco of the plague, from the Stories of St Nicholas of Tolentino.
DeAgostini/Getty Images
The First Quarantine
The
Adriatic port city of Ragusa (modern-day Dubrovnik) was the first to
pass legislation requiring the mandatory quarantine of all incoming
ships and trade caravans in order to screen for infection.
The
order, which miraculously survived in the Dubrovnik archives, reads that
on July 27, 1377, the city’s Major Council passed a law “which
stipulates that those who come from plague-infested areas shall not
enter [Ragusa] or its district unless they spend a month on the islet of
Mrkan or in the town of Cavtat, for the purpose of disinfection.”
Mrkan
was an uninhabited rocky island south of the city and Cavtat was
situated at the end of the caravan road used by overland traders en
route to Ragusa, writes Zlata Blazina Tomic in Expelling the Plague: The Health Office and the Implementation of Quarantine in Dubrovnik, 1377-1533.
Tomic
says that some medical historians consider Ragusa’s quarantine edict
one of the highest achievements of medieval medicine. By ordering the
isolation of healthy sailors and traders for 30 days, Ragusan officials
showed a remarkable understanding of incubation periods. New arrivals
might not have exhibited symptoms of the plague, but they would be held
long enough to determine if they were in fact disease-free. READ MORE: Pandemics that Changed History
The 30-day period stipulated in the 1377 quarantine order was known in Italian as a trentino,
but Stevens Crawshaw says that doctors and officials also had the
authority to impose shorter or longer stays. The English word
“quarantine” is a direct descendent of quarantino, the Italian word for a 40-day period.
Why
40 days? Health officials may have prescribed a 40-day quarantine
because the number had great symbolic and religious significance to
medieval Christians. When God flooded the Earth, it rained for 40 days
and 40 nights, and Jesus fasted in the wilderness for 40 days.
Stevens
Crawshaw says that even before the arrival of the plague, the biblical
notion of a 40-day period of purification had crossed over into health
practices. After childbirth, for example, a new mother was expected to
rest for 40 days.
Even
with the new quarantine law, Ragusa continued to be hit hard by
aftershock outbreaks of the plague in 1391 and 1397. As a maritime city
that survived on trade, it would have been impossible to completely wall
off Ragusa to disease without gutting the economy.
But even if
the quarantine measures didn’t fully protect Ragusans from disease,
Stevens Crawshaw believes that the laws may have served another
purpose—restoring a sense of order.
“There are risks with any
sort of epidemic of social breakdown, widespread panic, or complacency,
which can be just as dangerous,” says Stevens Crawshaw. “There are a lot
of emotions that need to be acknowledged and preempted and that was
part of public health policy 600 years ago as much as it is now.” PHOTOS: Innovative Ways People Tried to Protect Themselves From the Flu
The Plague of Florence in the 14th century, as described by Giovanni Boccaccio.
Bettmann Archive/Getty Images
Ragusa Also Built the First Plague Hospital
Quarantine
wasn’t the only tool in Europe’s ongoing battle with the plague, which
would periodically ravage the continent well into the 17th century.
Ragusa was also the first city to set up a temporary plague hospital on
another island called Mljet. This new type of state-funded treatment
facility would soon become known throughout Europe as a lazaretto.
Stevens Crawshaw, who wrote a book about plague hospitals, says that the name lazaretto is a corruption of the word Nazaretto, the nickname for the lagoon island upon which Venice built its first permanent plague hospital, Santa Maria di Nazareth.
The lazaretto served
two functions, as a medical treatment center and a quarantine facility.
It was a way to compassionately care for both new arrivals and local
citizens who fell sick with the plague while keeping them isolated from
the healthy. At a lazaretto, plague-infected patients would
receive fresh food, clean bedding and other health-promoting treatments,
all paid for by the state.
“They’re quite a remarkable early
public health structure into which the government has to invest huge
sums of money,” says Stevens Crawshaw. “Regardless of whether there’s a
plague in Venice, these hospitals are permanently manned, ready and
waiting for incoming ships that may be suspected of carrying an
infectious disease.” READ MORE: The First Time the Plague Broke Out in the US, Officials Tried to Deny It
