![]() Forty days were believed to represent the time necessary for dissipating the pestilential miasma from bodies and goods through the system of isolation, fumigation, and disinfection. Forty days was the period of the biblical travail of Jesus in the desert. The number 4 had particular significance. Another theory is that the number of days was connected to the Pythagorean theory of numbers. It is not known why 40 days was chosen as the length of isolation time needed to avoid contamination, but it may have derived from Hippocrates theories regarding acute illnesses. ![]() Treatment of the goods consisted of continuous ventilation wax and sponge were immersed in running water for 48 hours. Procedures for so-called “purgation” of the various products were prescribed minutely wool, yarn, cloth, leather, wigs, and blankets were considered the products most likely to transmit disease. Merchandise from ships was unloaded to designated buildings. In ports, lazarettos consisted of buildings used to isolate ship passengers and crew who had or were suspected of having plague. 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. Lazarettos were located far enough away from centers of habitation to restrict the spread of disease but close enough to transport the sick. In 1467, Genoa adopted the Venetian system, and in 1476 in Marseille, France, a hospital for persons with leprosy was converted into a lazaretto. ![]() The lazaretto was commonly referred to as Nazarethum or Lazarethum because of the resemblance of the word lazaretto to the biblical name Lazarus ( 12). 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. A rigid separation between healthy and infected persons was initially accomplished through the use of makeshift camps ( 10). Implementation of these measures required rapid, firm action by authorities, including prompt mobilization of repressive police forces. A sanitary cordon-not to be broken on pain of death-was imposed by armed guards along transit routes and at access points to cities. Thus, some city-states prevented strangers from entering their cities, particularly, merchants ( 10) and minority groups, such as Jews and persons with leprosy. Medicine was impotent against plague ( 8) the only way to escape infection was to avoid contact with infected persons and contaminated objects. 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). From northeastern Italy, the plague crossed the Alps and affected populations in Austria and central Europe. The pestilence then moved from ports in Italy to ports in France and Spain ( 9). 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). Organized institutional responses to disease control began during the plague epidemic of 1347–1352 ( 6). Since the fourteenth century, quarantine has been the cornerstone of a coordinated disease-control strategy, including isolation, sanitary cordons, bills of health issued to ships, fumigation, disinfection, and regulation of groups of persons who were believed to be responsible for spreading the infection ( 4, 5). ![]() Quarantine (from the Italian “quaranta,” meaning 40) was adopted as an obligatory means of separating persons, animals, and goods that may have been exposed to a contagious disease. Yet, a historical perspective of quarantine can contribute to a better understanding of its applications and can help trace the long roots of stigma and prejudice from the time of the Black Death and early outbreaks of cholera to the 1918 influenza pandemic ( 2) and to the first influenza pandemic of the twenty-first century, the 2009 influenza A(H1N1)pdm09 outbreak ( 3). The history of quarantine-not in its narrower sense, but in the larger sense of restraining the movement of persons or goods on land or sea because of a contagious disease-has not been given much attention by historians of public health. To lessen the risk from these new and resurging threats to public health, authorities are again using quarantine as a strategy for limiting the spread of communicable diseases ( 1). The risk for deadly infectious diseases with pandemic potential (e.g., severe acute respiratory syndrome ) is increasing worldwide, as is the risk for resurgence of long-standing infectious diseases (e.g., tuberculosis) and for acts of biological terrorism.
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