22 Feb Quarantine – history repeated

We are currently living through a pandemic that feels unprecedented and unique in its nature. However, it is not. It is neither something unique nor unusual, as pandemics have occurred throughout human history. And so did the well-known measures applied worldwide – wearing face masks, physical distancing, isolation and quarantine. Quarantine, in particular, has been used for a long time as a measure and safeguard against the spread of disease [1]. By looking at some examples from European history, we can learn how quarantining, probably one of the most detested measures against containing the virus, was practiced in the past.

From the Black Death to COVID-19: isolation and quarantine as public health measures

In Europe, the practice of quarantine began in the 14th century, when the bubonic plague – the ‘Black Death – ravaged through the continent. In 1377, the city of Ragusa (today Dubrovnik, Croatia) issued a 30 day isolation period for anyone trying to enter the city – called a ‘trentino’, from the Italian ‘trenta’, meaning 30. Marseille, Genoa, and Pisa introduced similar laws. In 1423, Venice set up a ‘lazaretto’, a quarantine bay for merchant ships; and extended the isolation period from 30 to 40 days. Thus, the ‘trentino’ became a ‘quarantino’; and Venice’s government became the first in the Mediterranean region who systematically used large-scale methods of isolation and information-collecting to monitor and fight infectious diseases [1,2,3,4].

All of these measures were introduced in the hope of stopping the devastating bubonic plague; and the forty-day quarantine practice was maintained for the next 300 years throughout Europe. Even though the Venetian quarantine was not enough to eliminate the virus in the city, it still proved to be an effective formula for handling outbreaks of the plague by slowing and minimising the spread of the disease and by making the inhabitants of Venice feel safe and looked after [1,2,3,4].

Despite its effectiveness, just like today, there were voices against quarantine measures. When in the 18th century quarantines were still used to control periodic outbreaks of the pest, social reformers came to think of it as an outdated measure [2].Without a scientific understanding of how disease spread, how was it possible to know the necessary duration for quarantine?

Such scientific knowledge of a disease is crucial, as it requires theoretical knowledge about the causes and methods of disease transmission to differentiate between a quarantine and isolation. Isolation, means the separation of sick people with a contagious disease from people who are not sick. Quarantine means the practices to separate and restrict the movement of people who were exposed to a contagious disease to see if they become sick [5]. As such, isolation can be seen as a precursor of quarantine. Throughout the history of disease, isolation was the primary method of halting the spread of pandemics, because the concept of an incubation period was not yet understood. With a better understanding of disease transmission and the so-called ‘Germ Theory’, sophistication and efficacy of quarantine began to improve, until it became a standard practice to fight disease [1].

Indeed, quarantines have been the official strategy for controlling infectious diseases for over 600 years: limiting contact between infected people has been at the heart of every state initiative to reduce infection – from the plague to swine flu [1]. The cholera outbreak in Europe in 1830, as well as the ‘Spanish Flu’ in 1918, were accompanied by severe restrictions on freedom of movement – as we can observe them today [4]. One of the most famous examples of quarantining appeared during a plague outbreak in England.

Eyam, a small village with a great impact

Eyam, a sleepy village in northern England is remembered for its brave and altruistic decision of going into voluntary quarantine, in 1666, after several of its villagers died of the bubonic plague. The details of the story vary from source to source. However, they all agree that the plague was brought to Eyam through a package of cloth delivered from London. George Viccars, a tailor and the recipient of the delivery, was the first plague victim of the village. Allegedly, he got bitten by a flea hiding in the wet garments, and died only three (or five, depending on the source) days later. Rather than fleeing the plague, the inhabitants of Eyam voluntarily isolated themselves from surrounding villages. Two thirds of the population died during the epidemic in the course of only 14 months. Nonetheless, they managed to prevent the disease from spreading, saving their neighbouring villages by facing infection and death [6,7].

The story says that between September and December 1665 already over 40 villagers of Eyam died as a consequence of catching the contagious disease. By the spring of 1666, many of the inhabitants were on the verge of fleeing the small village to save themselves. But that did not happen. Going into isolation was initiated by the new local parson, Wilhelm Mompesson, who found support in the previous incumbent Thomas Stanley. On the 24th of June 1666, Wilhelm Mompesson drew a boundary line approximately 800 meters outside of the village and instructed the villagers not to cross this line. Nobody was allowed to enter or leave the village anymore. As long as they agreed to quarantine, the Earl of Devonshire, who lived nearby, had offered to leave food and other essential supplies for collection at a safe distance for the villagers of Eyam. Mompesson decided to hold church services open air and to bury corpses in unconsecrated graves to prevent the mourners as well as the gravediggers from catching the disease [6,8]. Another story tells that, to be able to safely pay for supplies provided by outsiders, who left food and medicines at boundary stones around the outskirts of the village, people made little hollow spaces into these boundary stones and filled them up with vinegar to disinfect coins [7].  Allegedly, Mompesson even gave money to some villagers who were hard to convince to stay in isolation.

Whatever his methods were, they worked. Only a few villagers broke the curfew. The last plague victim in the village died around October or November 1666 [7]. According to Fanshawe (2012) [7], only 83 of the 350 inhabitants survived the plague outbreak in Eyam. Although Mompesson was successful in preventing the spread of the disease to the neighbouring villages, the strict and prolonged quarantine most likely contributed to the high death rate in Eyam itself.

Not only did Eyam save its surrounding villages from a similar fate, its choice to isolate from the outside world made for an informative case study for the evolution of infectious disease. What we can take away from this example of outstanding selflessness is encouragement for solidarity and collectively following the measures, as difficult and unpopular they may be. We can be certain that quarantining is a successful method to prevent the spread of infectious disease.

Authors: Viktoria Adler & Diotima Bertel, SYNYO

Sources

[1] Drews, K. (2013). A brief history of quarantine. Virginia Tech Undergraduate Historical Review, 2(1), pp.59-70. Available at https://vtechworks.lib.vt.edu/bitstream/handle/10919/90277/vtuhr-v2-drews.pdf?sequence=1 (18.02.2021)

[2] Lister, K. (2020).  A brief history of quarantine, and what it can teach us about social distancing today. iNews. Available at https://inews.co.uk/opinion/a-brief-history-of-quarantine-and-what-it-can-teach-us-about-social-distancing-today-423077 (18.02.2021)

[3] Center for Disease Control and Prevention (2020). History of Quarantine. Available at https://www.cdc.gov/quarantine/historyquarantine.html  (18.02.2021)

[4] Stub, S. T. (2020). Venice’s Black Death and the Dawn of Quarantine. Sapiens. Available at https://www.sapiens.org/archaeology/venice-quarantine-history/ (18.02.2021)

[5] Center for Disease Control and Prevention (2017). Quarantine and Isolation. Available at https://www.cdc.gov/quarantine/ (18.02.2021)

[6] Fanshawe, T. (2012). Eyam and “the last great visitation”. Significance, 9(5), pp. 38-41.

[7] Perehudoff (2008).  Eyam’s inspiring tale of sorrow and selfsacrifice. Toronto Star. 17.May.2008.

[8] McKenna (2016). Eyam plague: The village of the damned. BBC. 05.Nov.2016. Available at https://www.bbc.com/news/uk-england-35064071 (18.02.2021)