Quarantine: history repeats itself

Quarantine: history repeats itself

LitFest team member Robin Knight, who has a professional background in immunology, explores a medieval practice with renewed relevance for our own time.

This year’s LitFest theme was to be Breakaway, but the event had to be cancelled because of ‘the outbreak’. Instead of being free to do as we wished we have been restricted, curtailed, locked-down.

The notion of isolating those with a ‘contagion’ has existed since biblical times when lepers were forced to live alone: “His dwelling shall be outside the camp.” Lazar houses or leper hospitals were set up for such people but always outside the city to stop the contagion spreading, where they were kept in isolation being looked after by selfless nuns, friars or monks.

The practice of quarantine had been common in Italy and other southern European states since the 14th century as an attempt to protect coastal towns such as Venice (pictured above) from plague. Ships arriving from places where there was disease had to stay at anchor for 40 days before being able to land. The word quarantine is derived from the Italian for 40 days: quaranta giorni.

The first recorded quarantine measures in the British Isles were at Peebles , from 1468, in Edinburgh in 1498, and similar measures were later described in England from 1502 onwards, although these were largely local measures. In 1517 state quarantine measures were put in place for the first time in England at Windsor Castle; brought about by the personal fears of Henry VIII to the ongoing epidemic of plague and sweating sickness.

Social distancing is nothing new

These quarantine measures limited access into and out of quarantined houses. One person only was permitted to leave the house, to fetch food, drink and other necessities. While out of quarantine they had to carry a four-foot-long white rod upright, so that other members of the castle community could maintain their distance and avoid the possibility of infection. Social distancing is not new! These provisions were to be continued for 40 days after the last sign of infection, so that the threat of further infection had passed. We do not know how effective these measures proved to be or how well they were followed by those quarantined, but they were soon copied in London and Oxford.

Whereas many European cities had been quarantining plague victims since 1377 it was not until the Great Plague of London in 1665 that ‘plague orders’ were drawn up and strictly enforced in England.

An outdated practice?

Quarantine continued to be used to control periodic outbreaks of diseases such as yellow fever which killed thousands of people in places like the Caribbean. But by the 18th century some were starting to question its efficacy, regarding it as an outdated practice, while others thought it to be an infringement of their personal freedom. Benjamin Rush, an American physician wrote in 1801:

The commerce of our country has suffered greatly by our absurd quarantine laws in the different states. These laws, which admit the contagious nature of our American yellow fever, have produced a reaction in the governments of Europe which has rendered our commerce with the cities of Europe extremely expensive and oppressive.  

Quarantine measures were quickly imposed when cholera broke out in 1830 in Europe and two years later in the USA. Ships were not allowed into European ports if they had sailed from places with cholera, and restrictions were placed on freedom of movement in cities. There were those who thought that quarantine was ineffective and damaged commerce, and other even regarded cholera as a hoax, promoted by political opponents to damage their businesses!

Quarantine was defined in the 1911 edition of the Encyclopaedia Britannica as a “thing of the past in the United Kingdom and in the, majority of other states”, and an “old sanitary preventive system of detention of ships and men”.

Local authorities for many years maintained isolation hospitals for those with ‘contagious diseases’ and in many places built a separate ‘smallpox hospital’ as outbreaks of this deadly disease still occurred with irregular frequency. Smallpox is the only viral disease yet to be eradicated by world-wide immunisation.

Taking local control

Throughout history many communities have taken it upon themselves to isolate themselves during epidemics, as these snippets from the diary of an English missionary working in the far north of Burma illustrate:

October 1949More cases of smallpox and when I went to Hkinduyang to reclaim a book I have loaned, I found they had blocked the road to the village, and even cut down the bridge. The villages everywhere have blockades – fences across the road with symbols of a rope, a dah [sword] and a gun, showing that they will bind, cut and shoot everyone who enters their village and brings the epidemic!

January 1950 – the village has become extremely quiet and sleepy. News [exaggerated news] has spread that this village has fallen foul of small-pox, and consequently not a stranger has passed through the village that I have noticed. Furthermore my advice that people stick to their own houses, and only meet their friends out of doors, has been pretty well followed.

As the Great War was coming to an end in 1918, the Spanish flu pandemic struck. It possibly started on the Western Front with soldiers living in close proximity to one another, and and on their return home they spread the virus far and wide. Governments were unprepared after four years of war draining their resources and although some European cities closed schools, churches, theatres, banned mass gatherings and introduced social distancing and wearing face masks, it was too little too late, with up to 50 million losing their lives worldwide. 

So what has history taught us as we endure another pandemic? Not a lot, really, other than that history repeats itself. 

A Biomedical Scientist, before his retirement Robin Knight was the National Head of the NHS Blood & Transplant Red Cell Immunohaematology Reference Services. He has published 24 peer reviewed scientific papers and co-authored and edited five text books, two of which were published by the World Health Organisation.