The early spring of 2020 will no doubt take up some space in the history books. It marks a moment that was unprecedented in contemporary life: the first time in decades that governments around the world enforced strict social distancing measures– also known as quarantines.
In an attempt to slow transmission of a novel virus that ended up claiming millions of lives around the globe during its acute pandemic phase, governments enacted emergency public health measures that even your great-grandparents did not likely see in their lifetimes.
In a matter of days, life as we know it became unrecognizable. France went into a first lockdown on March 17th, barring residents and visitors from leaving their domiciles except to shop for essentials such as food and medicine, seek medical care, or get a bit of (solitary) exercise.
Borders closed and travel bans became a normal part of everyday reality in 2020, with a brief reprieve in the summer months and for some destinations giving way to a second wave of infections in autumn– followed by new lockdowns and travel restrictions.
But this certainly wasn’t entirely unprecedented, from the longer view of history. In fact, the toolbox governments and public health authorities turned to in a bid to save lives and avoid the wholesale collapse of hospital capacity is one that was devised hundreds of years ago.
Keep reading for a short history of quarantines in Europe– and why this seemingly “medieval” measure became necessary as we faced a deadly pandemic in our own time.
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The Medieval European Quarantine: It All Starts in Ragusa (now Dubrovnik)
Breaking out in Europe in around 1348, the Black Death had killed roughly a third of the continent’s population by 1359, leading governments grappling with ways to contain the threat.
This was a period of significant trade and travel, which– like today but on a much smaller scale– made stemming the spread of disease challenging.
Transmitted through flea bites, the bubonic plague spread rapidly through Europe from the far east, moving from Sicily through popular trade routes and ports, including those of the powerful city-states of Venice, Genoa, and Ragusa. The latter was a trading city in what is now Dubrovnik, Croatia.
Although the word “quarantine” has Italian origins– it relates to the term quaranta giorni, or “40 days” and references the period of isolation imposed on ships and people feared to carry the Black Death– most historians trace the first institutional application of a quarantine to Ragusa.
Believing the air itself to be infected, Ragusa implemented a strict regulation in 1377 that required new incoming ships, sailors and other individuals to remain offshore on nearby islands for at least 30 days.
A decree to that effect was published in Ragusa’s book of legislation, and declared the following in Latin:
Veniens de locis pestiferis non intret Ragusium nel districtum (Whoever comes from infected lands shall not enter Ragusa or its territory).
This followed from policies established in Genoa and Venice in 1374, which allowed officials to turn away ships arriving from plague-ridden areas. But Ragusa formalized the now-established practice of inspecting goods and isolating individuals.
(Side note: This new practice might be seen as a more compassionate and lawful response when compared to a recommendation from the Viscount Bernabo of Reggio, who had earlier advised that “every person with plague be taken out of the city in to the fields, there to die or recover”.
At first, the quarantines of Ragusa were established outdoors, with the theory that it would allow “purifying by sun and wind”. Viruses, bacteria and microbes had not yet been discovered and disease transmission was poorly understood.
To combat illnesses brought on by inclement weather, the quarantine areas evolved into sparse wooden buildings that were later referred to as lazzarettos. The word, of course, comes from Italian.
The establishment of formal quarantine “colonies” and the tightly controlled monitoring of individuals and goods gained a foothold in Venice, then around Europe.
In the 1370s, Venice’s senate body appointed a special council of three officials to enforce quarantines on ships and individuals entering the port. Eventually, the formal period of required isolation was extended to 40 days.
Some historians believe medieval health officials eventually favored a longer period because the plague was thought to run its course in around 37 days, while others cite Hippocrates’ notion that 40 days separates acute illnesses from chronic ones.
Whatever the rationale, 40-day isolation practices and lazzarettos became increasingly familar in Europe. Venice opened its first maritime quarantine in 1403, on the island of Santa Maria di Nazareth.
The Great Plague of Marseille & the Advent of Healthcare Infrastructures
The French port city of Marseille is famous for its own lazzaretto (lazaret in French) which was built in the 17th century as part of the Saint-Nicolas fort. It replaced an earlier, 16th-century space designed for quarantines on a different island.
Merchants, ship crews and their cargo were inspected by officials, and underwent a 40-day quarantine in the Lazaret before being permitted to enter Marseille.
Ironically, when a ship arrived in 1720 from Lebanon, the crew was initially subjected to a quarantine there for fears of a new wave of bubonic plague, but it was lifted prematurely.
This resulted in the death of 50,000 people, out of a population of 90,000. It eventually spread to nearby towns such as Aix-en-Provence, killing a further 50,000.
Eventually encased with fifteen-foot walls, the Lazaret d’Arenc quarantine facility was significantly bolstered following that terrible plague.
And in adjoining Aix, attempts to curb the spread of disease led to the erection of a “plague wall” (mur de la peste) in 1720, the same year the bubonic plague hit Marseille. Sadly, it didn’t do much to protect citizens.
Despite Marseille’s great disaster of 1720, the city is probably partly responsible for laying the groundwork for a more modern, organized and science-based response to dangerous illnesses.
Following an earlier plague in 1580, the city council of the Mediterranean port city created a sanitation board composed of council members and doctors.
The board made regular recommendations to protect the health of citizens in the city, and accredited doctors to prevent fraudulence and misinformation.
They established a complex health infrastructure that in some ways continues to inform France’s modern notion of the “cordon sanitaire” (roughly translated to “sanitary boundary”, a bureaucratic term for “quarantine”).
New Scourges and Medical Advances
Following the ravages of bubonic plague, European nations enforced further quarantines in an attempt to control the spread of numerous other communicable diseases– from leprosy to syphilis, yellow fever to cholera.
In 1831, cholera arrived in Bordeaux, prompting the great southern trading city in France to build its own large lazaret. Others were established along the west coast of France for the same purpose.
And in 1666, the English town of Eyam self-imposed a quarantine after its citizens began perishing from a strange disease. Ferne Arfin of The View From Chelsea has a riveting account of this remarkable act of self-sacrifice.
Their quarantine proved more successful at saving lives than less organized counterparts in London in 1665, which did not prevent the death of up to 100,000 in the city from a new wave of plague.
Also in 1666, the German city of Frankfurt issued a decree banning individuals living in plague-infected houses from visiting public places including churches and markets.
It also prohibited the removal or sale of clothing from deceased victims before fumigating and thoroughly cleaning garments.
During the nineteenth century, medical knowledge advanced rapidly, leading to the first international gatherings of health bodies and governments.
The first of these “sanitary conferences” was held in Paris in the middle of the 19th century, and in some ways predated global bodies such as the World Health Organization.
One of their central preoccupations was to devise a more coordinated response to global epidemics of diseases such as plague and cholera, which spread to Europe from Egypt and Turkey during the period.
The advent of bacteriology in the 1890s allowed medical authorities to tie diseases such as typhoid and cholera to specific pathogens, leading to new quarantine procedures and isolation periods.
Unlike the quarantines of the past, these were now often determined based on the life cycles and behavior of specific microbes.
A 20th Century Pandemic, & the Decline of the Mass Quarantine
In 1918, a virulent strain of influenza (flu) spread around the world and killed up to 50 million people through late 1919. Erroneously called “Spanish Flu”– it is in fact thought to have first broken out on a military base in the US– the pandemic tore through the world like an invisible monster.
But unlike some of the more vigorous quarantine efforts of the medieval period, Renaissance, and nineteenth century, the response in Europe this time was messy, generally inadequate– and deeply fatal.
Europe was battered by years of war and weakened infrastructures, including a health care system that had been focusing its energies on attending to wounded soldiers.
According to French magazine Geo, officials in France and Paris grappled with how to stem the tide of deaths.
The country was still in the throes of the final months of World War I, and it was difficult to respond to this new, impersonal enemy while maintaining the war effort.
Public gatherings were banned and people were encouraged to limit their social activities. Cordons sanitaires were established in areas with large outbreaks, effectively placing them under quarantine.
But trains continued to operate, and France did not attempt to block an influx of American troops.
Nor did they wish to “demoralize” their own soldiers with overly-stringent quarantine measures. The virus reached the trenches and killed thousands.
In Caen, theatres closed; in Paris, schools shuttered and Parisians were flooded with dubious information about how to prevent– or even cure- the disease.
They flushed nasal passages with hot water “fortified” with bleach. They drank rum, erroneously believing it had medicinal properties capable of preventing infection.
The city itself even ordered hundreds of litres of the alcoholic drink as part of its “prevention” plan, supplying it to pharmacies as a curative method.
By June 1919, France had lost nearly 410,000 citizens in less than a year. Many today attribute the deaths in part to inadequate or unevenly applied quarantine procedures.
Reeling from the unprecedented loss, countries around the world came together following the pandemic of 1918 to form bodies such as the World Health Organization.
Today, as we face what might be only the beginning of a new pandemic that is already challenging our way of life and sense of security, it seems wise to consider the long history of the quarantine through new eyes.
Will tougher measures allow us to avoid the sort of mass tragedy that the world saw in 1918?
Only time will tell. Here’s to hope.