When It Happened Before: An NIH paper on historical epidemics

I ran across the paper quoted below about epidemics and pandemics of the past, published by the US’s National Institute of Health in 2013.  It makes for interesting reading.

The biggest difference between this pandemic and those before the late 20th century is politics.  Yes, the speed of travel makes the spread much faster, but the interaction between governments and what they can justify (read: get away with) has changed drastically.  Unprovoked war measures can no longer be justified against neighbors, not even by China.  It’s not 1945 anymore – during epidemics and pandemics from the 1968 flu until now, governments tread carefully.

During the Black Plague, groups and nations would isolate themselves, sometimes enacting “shoot to kill” policies to outsiders and creating quarantine zones (oft times islands) to place all the infected and keep them away from the rest of society.  In modern politics, countries can’t afford to take a “first strike” attitude towards approaching foreigners.  They can ban airplanes from landing, but they dare not shoot one down as they might have shot people walking and on horseback hundreds of years ago.  We’re not talking about zombies.

Lessons from the History of Quarantine, from Plague to Influenza A


In the new millennium, the centuries-old strategy of quarantine is becoming a powerful component of the public health response to emerging and reemerging infectious diseases. During the 2003 pandemic of severe acute respiratory syndrome, the use of quarantine, border controls, contact tracing, and surveillance proved effective in containing the global threat in just over 3 months. For centuries, these practices have been the cornerstone of organized responses to infectious disease outbreaks. However, the use of quarantine and other measures for controlling epidemic diseases has always been controversial because such strategies raise political, ethical, and socioeconomic issues and require a careful balance between public interest and individual rights. In a globalized world that is becoming ever more vulnerable to communicable diseases, a historical perspective can help clarify the use and implications of a still-valid public health strategy.

There’s more quoted below the fold.



Organized institutional responses to disease control began during the plague epidemic of 1347–1352 (6). The plague was initially spread by sailors, rats, and cargo arriving in Sicily from the eastern Mediterranean (6,7); it quickly spread throughout Italy, decimating the populations of powerful city-states like Florence, Venice, and Genoa (8). The pestilence then moved from ports in Italy to ports in France and Spain (9). From northeastern Italy, the plague crossed the Alps and affected populations in Austria and central Europe. Toward the end of the fourteenth century, the epidemic had abated but not disappeared; outbreaks of pneumonic and septicemic plague occurred in different cities during the next 350 years (8).


Quarantine was first introduced in 1377 in Dubrovnik on Croatia’s Dalmatian Coast (11), and the first permanent plague hospital (lazaretto) was opened by the Republic of Venice in 1423 on the small island of Santa Maria di Nazareth. The lazaretto was commonly referred to as Nazarethum or Lazarethum because of the resemblance of the word lazaretto to the biblical name Lazarus (12). In 1467, Genoa adopted the Venetian system, and in 1476 in Marseille, France, a hospital for persons with leprosy was converted into a lazaretto. Lazarettos were located far enough away from centers of habitation to restrict the spread of disease but close enough to transport the sick. Where possible, lazarettos were located so that a natural barrier, such as the sea or a river, separated them from the city; when natural barriers were not available, separation was achieved by encircling the lazaretto with a moat or ditch. In ports, lazarettos consisted of buildings used to isolate ship passengers and crew who had or were suspected of having plague.


The first English quarantine regulations, drawn up in 1663, provided for the confinement (in the Thames estuary) of ships with suspected plague-infected passengers or crew. In 1683 in Marseille, new laws required that all persons suspected of having plague be quarantined and disinfected. In ports in North America, quarantine was introduced during the same decade that attempts were being made to control yellow fever, which first appeared in New York and Boston in 1688 and 1691, respectively (18). In some colonies, the fear of smallpox outbreaks, which coincided with the arrival of ships, induced health authorities to order mandatory home isolation of persons with smallpox (19), even though another controversial strategy, inoculation, was being used to protect against the disease.


In some countries, the suspension of personal liberty provided the opportunity—using special laws—to stop political opposition. However, the cultural and social context differed from that in previous centuries. For example, the increasing use of quarantine and isolation conflicted with the affirmation of citizens’ rights and growing sentiments of personal freedom fostered by the French Revolution of 1789. In England, liberal reformers contested both quarantine and compulsory vaccination against smallpox. Social and political tensions created an explosive mixture, culminating in popular rebellions and uprisings, a phenomenon that affected numerous European countries (29). In the Italian states, in which revolutionary groups had taken the cause of unification and republicanism (27), cholera epidemics provided a justification (i.e., the enforcement of sanitary measures) for increasing police power.