“It is the Plague, and the dread of the Plague, that divide the one people from the other”, wrote Alexander Kinglake in his 1844 travel memoir, Eothen. For Kinglake, the threat of epidemics formed a barrier of fear between the east and west.
Infectious disease has ravaged populations since ancient times, bringing pain and terror to families and communities; sorting humanity into the ‘clean’ and the ‘foul’. With deadly outbreaks come efforts to contain and eradicate the threat – but as we have seen from the reported rise in racism against Chinese people in the wake of the recent coronavirus COVID-19, sometimes exclusion of the disease takes human dignity with it.
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When and where did the first quarantines take place?
The separation of the sick and healthy has occurred throughout history. As far back as the book of Leviticus, priests could isolate those with a “defiling skin disease” – likely to be leprosy – for seven days. The history of quarantine, however, is about more than keeping sufferers at arm’s length. The first organised quarantines in medieval Europe reflect an awareness of the silent presence of disease in the apparently healthy too.
With repeated plague outbreaks decimating medieval Europe during the 14th century, port authorities in the Adriatic Sea responded with the first structured quarantine arrangements. In Venice, Italy, incoming ships were detained in the lagoon, while at Ragusa (present-day Dubrovnik, Croatia), a 1377 edict forbade people and goods from infected countries to enter the city until they had spent a month on an uninhabited island, being purified by the sun and the wind. This later became 40 days, hence the term ‘quarantine’ from the Italian quaranta (meaning 40). The length of time not only aligns with Hippocratic ideas about turning points in the course of disease, but also reflects concepts of spiritual purification evident in Jesus’s time in the wilderness.
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The island of Santa Maria di Nazareth in the Venetian lagoon housed the first known maritime quarantine station from 1423. As both a plague hospital and leprosarium, it was dubbed Lazzaretto – probably due to its association with the St Lazarus Hospital for Lepers. When in 1468 the Lazzaretto Nuovo was established to accommodate those suspected of disease, the first island became Lazzaretto Vecchio. It is possible to visit its eerie abandoned buildings today and imagine the fear and isolation of those detained within sight of ordinary life on Venice’s Lido.
Other lazarettos sprang up along the Mediterranean coastline and were a principal form of disease control throughout the early modern period and 19th century. Conditions varied – but could leave a lot to be desired.
In the 1780s, for example, English prison reformer John Howard took his investigative spirit beyond the call of duty by purposely joining a Venice-bound ship with a “foul bill of health” – ie one travelling from a plague area – to sample lazaretto life. He reported his grim findings in An Account of the Principal Lazarettos in Europe (1789).
The Lazzaretto Nuovo was squalid. Howard was shown to “a very dirty room, full of vermin, and without table, chair, or bed”. He was soon transferred to the Lazzaretto Vecchio, but was disappointed again. For six nights he slept on a damp brick floor, before moving to rooms with a better view but a smell “no less offensive than the worst hospital”. Losing his appetite and feeling feverish, Howard managed to get the walls whitewashed, which neutralised the odour and made the rest of his stay tolerable.
Meanwhile in North America, concerns centred on yellow fever and smallpox, and by the early 1700s all the substantial ports of the eastern seaboard had quarantine arrangements – such as requiring ships to remain in port displaying a yellow flag until sufficient time had elapsed. The effectiveness of such measures is questionable since yellow fever is spread by mosquitoes, who presumably flouted the restrictions.
As cholera emerged in the 19th century it, too, became a feared disease – and one associated with the influx of immigrants. Although the 1832 British epidemic reached New York in spite of restrictions on ships, measures were more successful in 1866 when the steamer Virginia arrived from Liverpool having lost 38 passengers to cholera en route. The vessel was placed in the Lower Quarantine bay about 20 miles from the city, with a hospital ship to assist sufferers. An outbreak did occur on land, but was limited.
As the causes of disease became better understood, quarantine could be tailored to the specific germs posing the threat –but medieval fears lingered. The dreaded plague never went away, and the third pandemic emerged in China in 1855, eventually leading to outbreaks on every inhabited continent at around the turn of the 20th century.
Demonising ‘outsiders’: how anti-Asian prejudice led to quarantine
In the United States, existing anti-Asian prejudice fed on the disease’s Chinese origin. When lumber yard proprietor Wong Chut King died of suspected plague in San Francisco in 1900, the authorities forcibly quarantined Chinatown, roping it off and surrounding it with police. Restrictions targeted ethnicity, not the likelihood of contact with the disease – white people were allowed to leave while Chinese people were contained. Although the unjust quarantine was quickly lifted, it represented an underlying fear of immigration as the source of disease. During the 1890s, a typhus outbreak on an immigrant ship led to the detention of 1,200 Russian Jews, and well into the 20th century new arrivals at Ellis Island faced segregation based on suspicion of infection.
Disease control measures such as vaccines and antibiotics reduced the emphasis on quarantine during the 20th century, but the isolation of people suspected of communicable disease has persisted, sometimes going hand in hand with draconian laws. Quarantine was credited with restricting the impact of SARS in 2003, but it involved the Chinese government threatening execution or life imprisonment for those spreading the virus.
It remains to be seen whether the quarantine and isolation measures currently in use against COVID-19 will prevent a global pandemic, but history shows that there’s a balance to be struck between the vital aim of disease prevention and the risk of curtailing the liberty of individuals and demonising outsiders.
Caroline Rance is the author of Kill-Grief (2009), The Quack Doctor: Historical Remedies for All Your Ills (2013) and The History of Medicine in 100 Facts (2015). You can visit her website and find her on Twitter @quackwriter