On Quarantine

This week marks the establishment of the U S Naval Quarantine of Cuba in 1962.  President Kennedy ordered the Naval blockade and associated diplomatic actions in order to convince the Soviets to remove nuclear weapons they had clandestinely placed in that island nation.  In a sense, one could say Mr Kennedy and his advisors hoped the quarantine would “sanitize” the island of the threat posed to the United States by having nuclear armed missiles just 90 miles off our coast.

We normally think of the term quarantine in a medical context:  the sequestration of infected patients to prevent the spread of contagion to the general population.  Our notions of contagion and of a response to it emerges from the earliest time of written history.  Gabriel and Metz, in their two-volume History of Military Medicine quote a Sumerian physician’s letter to a family that was housing a sick person giving strict orders that ‘no one should drink in the cup where she drinks, …nor sit in the seat where she sits,…no one should sleep in the bed where she sleeps’ (he goes on to advise that she stop seeing visitors because her disease is sabtu, “catching)–as evidence that Sumerians (4,000 – 2,000 BC) had some notion of hygiene and contagion.  The authors go on to cite Sumerian cautions about avoiding mosquitoes and flies (Nergal, the Mespoptamian god of disease and death was personified as a fly) as further evidence of their practical understanding of insects as vectors for disease despite “official” demon theories of disease operative at the time.  By around 1000 BC, Mosaic laws called for quarantine of sick persons or families for up to 40 days, with ritual purification of the clothing, house and possessions of the sick, if the illness did not abate.  Vivian Nutton tells us that “Thucydides, in his Greek account of the Athenian plague, talks about the passage of disease from person to person without any hint that this opinion was unusual.”  He goes on to say, however, that neither the Greeks nor the Romans appear to have understood the significance of this person-to-person spread of illness to make the conceptual leap to “quarantine”.

From the late Roman empire until the European Renaissance, it appears that, from the standpoint of public health measures to prevent contagion, things went from bad to worse.  By the 12th Century, Islamic medical writers, who had in the 9th and 10 Centuries assiduously translated and adopted the wisdom of ancient Greek medical authorities, were now often criticized for describing the plague as contagious.  Peter Pormann and Emilie Savage Smith tell us that while debate raged on, Islamic doctors now generally sought the cause of disease in demons, or even the Deity himself.  In Christian Rome and Europe of the post-Roman era, theological causes and cures for disease were propounded and even celestial bodies invoked as a cause for disease.   David C. Lindberg cites as an example the medical faculty of the University of Paris conclusion that the black death of 1347-51 had been the result of a corruption of the air caused by the conjunction of Jupiter, Saturn and Mars in 1345.

By the late fifteenth and early sixteenth centuries, however, medical humanists were beginning to produce new translations of ancient Greek medicsal authorities, and of  Arabic translations of the same writers.  As a result, a spirit of empirical observation began to permeate medical thought, as physicians began to look for natural causes for disease.  According to Guenter Risse, repeated waves of the devastating black death prompted local governments– first in Italy then spreading throughout Europe–to institute public policies to deal with the contagion.  Initially, these policies aimed to blunt the impact of epidemic by denying entrance within city walls of sospetti–plague victims, and their possession, including cargo.  Within cities, authorities isolated the sick in their homes, and saw to it that the filth causing the stinky miasma suspected of spreading the illness was cleaned up.  After 1400, cities in central and northern Italy began to appoint health commissions to deal with epidemics.  In 1423, the city of Venice established a lazzaretto on an island in the Venician lagoon specifically for the isolation of foreign traders suspected of carrying pestilence–and their cargoes.  That these sospetti were to be isolated for 40 days is taken to have given the term “quarantine” its name, being derived from “quaranta”–Venetian Italian for 40.  During the plague of 1468, officials of Milan studied the transmission mechanisms of the disease through careful contact tracing.  This work confirmed the important role of contagion in the transmission of plague.   After 1500, governments gathered intelligence about the movement of  plague throughout Italy and the Mediterranean basin by utilizing a troop of disease spies on the public payroll.

The major late 19th and 20th Century innovation in epidemic control was the institution of mass immunization, first against smallpox, starting around World War I, and now most notably against rapidly emerging influenza strains.

Today, governments and international agencies have active disease surveillance programs in place throughout the world.  In the 2005 bird flu scare, the Centers for Disease Control and Prevention sought strict rules for identifying and tracking potentially ill travelers, while the Chinese government and others isolated travelers identified by remote fever-detectors.  Meanwhile, pharmaceutical companies worked feverishly to produce vaccinations against the newly virulent strain of virus.

Lessons learned during and since the European renaissance are applied in today’s world.  And insofar as we give it the name “quarantine”, one response to epidemic disease arose in a maritime nation–Venice.  And so maritime medicine can claim some historical credit for any success we enjoy in contagion control today.

[Please note:  the links in this posting will direct you to listing of the authors’ books; if you purchase any of these, the Society for the History of Navy Medicine will benefit by receiving a nominal “commission”.]

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