At this time when the world is desperately grappling with the coronavirus pandemic, the buzz words are mask wearing, social distancing and quarantining. As at now, due to the unavailability of an appropriate vaccine, it is recognized these techniques are the only effective weapons in the fight against the spread of the disease.
These sanitary precautions, however, are no new discoveries of modern times. Our distant forebears in the fourteenth century used these techniques during the ‘Great Pestilence’ or what came to be known as the Black Death, the bubonic plague, that ravaged Europe with calamitous consequences from 1347 to 1351.
The Black Death posed a huge challenge to medieval rulers forcing them to think out of the box – how to respond to a gruesome epidemic that mercilessly went on a killing spree. Deploying ingenuity and common sense, Italian physicians came to comprehend the causes and behaviourial pattern of the virus. They understood how the virus survived on human beings, hopping from person to person through fleas carried by black rats. They became aware of the contagious nature of the disease and that separation of the healthy individuals from those contaminated was the only option to slow down the pandemic’s mad race. The very notion of keeping people in strict isolation emerged.
City-state of Venice
The Black Death erupted in Italian cities in 1347 with connivance of visiting plague-infested ships and spread across Europe wiping out an estimated 60% or 20 million of Europe’s population, according to Cardinal Francis Aidan Gasquet in his book ‘The Black Death’ (1908). In England, the death toll stretched to an estimated two and a half million out of a population of four million, wrote the historian G.M Trevelyan.
But then, of all the places, it was the city-state of Venice (Italy was then made up of many small territorial states and only became a single nation in 1861) that took the lead in developing quarantine measures.
The Venetian authorities clamped down tight control on ships entering Italian ports. Thus, it became mandatory for ships with all their loads, crew and passengers, whether exhibiting symptoms of plague or not to stay confined offshore for a “trentino”, that is, for a 30-day period. Ships had also the obligations to signal by waving a red flag if sickness or mortality had occurred on board.
But that 30-day isolation period was later extended to a “quaranta” or “quarantino”, a 40-day period. According to the historian, Jane Stevens Crawshaw, the choice of a 40-day period meant for “purification” from diseases bore in medieval times a biblical and symbolic significance. Though various time-periods were later adopted by different countries to determine the length of isolation, the term ‘quarantine’ derived from the Italian ‘quarantino’ has ever since retained its originality.
Though sea and inland caravan travellers were screened and quarantined before being allowed into Italian cities, the execution of the plague containment measures suffered a setback. Leave alone people’s indifference to sanitary measures to stem the plague, the efforts of the Italian health authorities were frustrated by people’s beliefs and blinded faith in supernatural causes.
For example, God-fearing people resigned themselves to the fact that the epidemic was a manifestation of God’s wrath to punish sinners and so formed groups, walking the streets barefoot and crying for God’s forgiveness. The flagellants, for their part, roamed villages beating themselves and others with whips, running iron-spikes to mutilate their bodies as a mark of penitence to obtain divine mercy. Still others resorted to witchcraft to chase away the evil spirits and “bad airs”. Those mass gatherings and the flagellant movements instead of appeasing God’s anger were like fuel causing the plague to spread like wild fire. Those from the higher society using their common sense fled the overcrowded towns to seek refuge in the “villeggiaturia” – the countryside retreats – which Professor James Hankins of Harvard University writes was already “a form of social distancing”.
But the weakness of the plague-containment strategy by the Venetian authorities merely served as guidelines. It had no legal force. The absence of legal provisions to discipline a population steeped in their own beliefs, traditions and superstitions and throwing all practical solutions to the wind led to the failure of the quarantine system, an otherwise laudable initiative, put in place by the Venetian authorities.
The republican city of Ragusa, by contrast, pursued a more rigorous approach to cope with the periodical outbreaks of epidemics. Ragusa (modern-day Dubrovnik) located on the coast south of Croatia on the Adriatic Sea, depended on maritime trade for its economic survival.
To the Ragusan government, protection of its citizens from recurring diseases was synonymous with good governance. Hence, it came up with legislations regulating the operation of the quarantine system which included provisions for punishment to be meted out to offenders.
The historians Zlata Blazina Tomic and Vesna Blazina remind us in their book “Expelling the Plague….1377-1833”, that it was the “city-state of Ragusa that was the first in the world to develop the concept of quarantine legislation as early as 1377”.
The Great Council of Ragusa on 27 July, 1377, as pointed out by Tomic and Blazina, voted a law to the effect that “individuals who come from plague infested areas shall not enter Ragusa or its district unless they previously spend a month on the islet of Mrkan or in the town of Cavtat, for the purpose of disinfection”.
« Punishment for those contravening official health regulations included fines, physical torture, flogging with ropes, cutting off of one ear, and in some rare cases, death by hanging! »
The decree stated that individuals entering the city had to take an oath confirming they had arrived from disease-free places. Those giving false information were arrested, punished and quarantined.
Furthermore, the authorities warned the residents that they “are strictly forbidden to visit those who arrive from plague-infested areas and who will be confined on the islet of Mrkan (uninhabited rocky island) and Cavtat. Those who dare bring food or any other necessities to the interned without permission of the officials designated for that function will have to stay there in isolation for a month”.
Punishment for those contravening official health regulations included fines, physical torture, flogging with ropes, cutting off of one ear, and in some rare cases, death by hanging!
Indeed, the severity of the Ragusan quarantine laws might have inspired the Egyptian authorities. Down the centuries, the Egytian ruler, Mohammed Ali, was unrelenting in case of non-compliance with sanitary regulations. Infected people were sent to pest houses to recover or die. Households’ heads who failed to report that a family member had died of plague had to pay a heavy price: they were shot.
Health officials in Ragusa, enforcing the quarantine regulations had a dual responsibility. They also served as Judges to hand out punishments. They were empowered to burn the houses and belongings of plague victims. But the government did not hesitate to impose fines on Judges themselves if they failed in their duty to apply the legal sanctions voted by the Council.
The Ragusan government adopted firmness in maintaining discipline among its population. But at the same time, it showed concern by the setting up, according to Crawshaw, of a plague hospital or what was called the ‘lazaretto’, the first of its kind in the world, in 1390, for the confinement, treatment and well-being of its citizens afflicted with diseases.
Ragusa’s quarantine’s edict served as a model for many countries when dealing with infectious diseases. England drew up its quarantine regulations in 1663. France followed in 1683.
The Ragusan experience of zero-tolerance against breach of quarantine regulations might be the panacea for keeping at bay the Covid-19, perhaps as deadly as the Black Death 700 years ago.