Quarantine - an early modern approach
Jane Stevens Crawshaw |
Does quarantine work? If ‘yes’, when is the right moment to impose a total lockdown? How should households and the state prepare? Is the stockpiling of essential goods sensible or ‘shelf-ish’?
Governments, media outlets and communities across the globe are attempting to answer these questions in response to the COVID-19 virus. As medical researchers investigate this new strain of infectious disease, the potential economic and social impacts, both of the virus and any attempts to mitigate it, are also being evaluated. Alongside these contemporary insights, we may be able to deepen our reflection on one public health policy – quarantine – by looking to the past. Few of the questions posed today about the implementation, effectiveness or impact of quarantine are new. Indeed, many lay at the heart of debates about public health for epidemic disease from the earliest examples of systematic quarantine – a policy which was developed in the major commercial trading centre of Venice during the fifteenth century.
Quarantine has always encompassed a number of distinct policies and processes, ranging from the containment and observation of people and their goods who were believed to be at risk of infection, to the isolation and treatment of the sick and the convalescence of those who recovered from the disease. The actual term ‘quarantine’ derives from the word ‘quaranta’ meaning forty in Italian. A period of forty days was adapted to a public health context during the fifteenth century because of its broader biblical, liturgical and symbolic significance. Nevertheless, public health officials of the period also recognised that periods of quarantine ranging from seven to fifty days should be applied to individuals according to specific circumstances. It was generally not until an epidemic reached a perceived peak, for example during the summer of 1576, that blanket policies were imposed. In Venice at this time, for example, women and children (under 18s) were confined to their parish and were not allowed to meet in public squares or any other location. These city-wide policies were used for short periods in order to limit their economic effects – which, of course, also underpinned the gendered nature of the policy.
Debates about the efficacy of quarantine (whether household, institutional or district) are as old as the policy itself. Critics focus on the direct and indirect economic and emotional costs. Governments often worked directly to try to mitigate these but, in so doing, amassed significant costs for the public purse. The care in Venice’s original quarantine hospitals, for example, was free for inhabitants of the city and seen as a form of charity. As the historian John Henderson has shown, during a general quarantine in Florence in 1630-1, the government supplied the basic needs of approximately half of the total resident population (over thirty thousand people). The distribution system also offered an opportunity for employment, thereby undermining the enduring association between quarantine and loss of earnings, which has often been the basis for resistance. Indeed, it may well be that the people who are most inconvenienced by quarantine (working age adults) are those who perceive themselves as receiving the least benefit from it, as many diseases will disproportionately target other demographic groups.
Regulating border crossings proved to be an enduring challenge. Early modern governments relied on systems of collaboration and communication crossing political borders on the continent. In the early modern period, states developed systems of health passes to facilitate essential travel and work alongside criminal penalties for unauthorised violations of quarantine, such as thefts of goods or surreptitious visits to friends or family.
Officials recognised, however, that the success of quarantine policies lay in convincing communities of their benefits since, both past and present, governments have lacked the resources to enforce compliance. By addressing the emotions and behaviours of the public (including fear, complacency and boredom), officials attempted to encourage community participation, for example, by making the spaces and conditions of quarantine as pleasant as possible. Domestic quarantine was, consequently, preferred but where institutions were used they included prominent gardens or religious architecture, which were designed to bring comfort to patients. In the penal reformer John Howard’s plan for an ideal isolation hospital in 1789, he included a centrally-placed bowling green. Separate spaces were also created for the treatment of dangerous or vulnerable social groups, including those without a familial household unit like prisoners and orphans.
Another vital role for the state was the dissemination of high-quality information, including regularly-published infection and mortality statistics. Even this did not prevent people from filling perceived gaps with misinformation, including accusations of culpability for the origins or spread of disease, which brought long-standing social prejudices to the fore. Misinformation about effective medical protections or cures also abounded. Officially-appointed Health Office doctors in early modern Italy provided printed tests and publicised their medical secrets to try to limit the impact of ‘fake news’ and quacks’ remedies.
Quarantine’s early development was largely limited to Europe. From the eighteenth century, when plague abated in Europe, quarantine policies were imposed at the borders of the continent and the policy was exported in the context of nineteenth-century European colonialism. New forms of quarantine also came to be developed across the globe in the Ottoman Empire and Asia. Political tensions have had enduring effects on the administration of quarantine, not least because the policy has often been associated with protection at national borders.
Ultimately, though, at the heart of effective quarantine lies a sense of community and trust in public institutions. National or local quarantine schemes can and should make provision for the elderly, vulnerable or marginal members of society. Historically, the earliest quarantine policies were shaped by charity and compassion. Perhaps the greatest lesson and challenge of the past is that it reminds us that the way in which societies respond to epidemic disease reveals much about their priorities and ideals.Please note: Views expressed are those of the author.
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