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Ebola has put it in the headlines. Quarantine:  an old and inescapable solution to the never-ending problem of contagious disease. Long before Louis Pasteur demonstrated the agents of disease transmission, people recognized and feared the spread of certain afflictions. Victims of dreaded diseases were removed from public contact. People thought to be contagious were put in walled enclosures, kept in their homes, or put in isolation rooms. In times of plague, cities closed their gates and those who were well avoided crowded streets and markets.

Pasteur identified Streptococcus as an infectious bacteria in 1878.

Pasteur identified Streptococcus as an infectious bacteria in 1878.

The practical and ethical questions we struggle with today are very human dilemmas that people have wrestled with throughout history. Do we isolate people who are sick, people who might become sick, or the entire household of an exposed individual? What happens to their clothes and belongings? How do we handle waste, disinfection, treatment, and burial? Is there public compensation for the losses of quarantined individuals? Are there exceptions to quarantine laws: medical professionals, military, missionaries, diplomats, the wealthy, the powerful, VIP’s? Resolving these issues requires a combination of civil and medical input. News articles point this out today: See, for example, “Doctors, experts fight quarantines for those treating Ebola patients” (Dallas News http://www.dallasnews.com/ebola/headlines/20141026-doctors-experts-stop-the-ebola-quarantines-after-nurse-felt-like-prisoner.ece).

Charlemagne  (d. 814 CE) decreed that lepers be quarantined.

Charlemagne (d. 814 CE) decreed that lepers be quarantined.

In 789 Charlemagne barred lepers from contact with the general population. (Miller, 10). The victims were often kept in enclosures outside the city walls. Later, the same lazarettos were used to isolate plague victims. The Lazaretto built in 1488 outside Milan was huge. During epidemics, it housed as many as 10,000 patients. (Girourd, 46).  Managing crises of this magnitude required more authority than individual physicians could muster. European public health systems began in Italian cities with commissions of doctors which at first were called up by city officials in response to epidemics and in time became ongoing institutions.

Seventeenth-century plague doctor in protective gear.

Seventeenth-century hazmat suit: a plague doctor in protective gear.

Quarantines become ineffective when disease is spread by vectors such as fleas or mosquitos. In 1792, local governments in Guangzou and other parts of Yunnan, China, faced a series of three plague epidemics. Previous plagues had been associated with rats, so public health measures included collection and burial of dead rats outside the city walls, burying the dead victims and burning their clothes, cleaning the streets, and removal of garbage rather than allowing it to be sold. Communities brought in doctors, treated the sick, and implemented quarantines. (Benedict,142-44). The attempt to eradicate rats made sense at the time, but since the city officials did not know that disease was actually spread by fleas, rats were only part of the problem.

1933 letter to the editor from the President of the Office International d'Hygiene publique.

1933 letter to the editor from the President of the Office International d’Hygiene publique.

The role of the mosquito in malaria, yellow fever, and West Nile virus was deciphered at the dawn of airplane transportation. Newspapers reported the concerns with containing the diseases in a world made smaller by air travel. In the Feb. 25, 1933, edition of the Times of London, a prominent health official tries to stave off panic, warning against “alarmist prophecies or speculations, regarding the future spread of the disease.” A 1940 article, “Disinsectization of Aircraft” (Williams, 1088) describes a method for spraying passenger compartments of planes entering the U.S. from South America with a petroleum-based insecticide to eradicate any mosquitoes on board.

1940: Insecticide sprayer used in some airplanes.

1940: Insecticide sprayer used in some airplanes.

It’s difficult to imagine this method being even remotely acceptable today, but the concern with air travel is very much alive, as can be seen on the Centers for Disease Control web site Quarantine and Isolation: “Ebola Guidance for Airlines,”  http://www.cdc.gov/quarantine/air/managing-sick-travelers/ebola-guidance-airlines.html . (This web site has recommendations for measles, flu, cholera, and other diseases, in addition to Ebola. )

As a society, we are still learning about the best ways to manage infectious diseases. Management is the key, because diseases are an integral part of our world. From the past, we can see that quarantine can only be as effective as our understanding of the disease and how it is spread. This is an ongoing and humbling process in which our best scientific conclusions today may be subject to revision tomorrow. Although quarantine is only a part of disease control, specific measures must be carefully weighed, since they profoundly impact the lives, freedoms, and legal rights of individuals. Disease management must be a carefully-considered balance of civil law and medical knowledge.

References:

Benedict, Carol. “Bubonic Plague in Nineteenth-Century China,” Modern China, Vol. 14, No. 2. (Apr., 1988), 107-155.

Girourd, Mark. Cities and People (New Haven: Yale University Press, 1985).

Miller, Timothy S. and John W. Nesbitt, Walking Corpses: Leprosy in Byzantium and the Medieval West (Ithaca: Cornell University Press, 2014).

Williams, C. L., “Disinsectization of Aircraft,” Public Health Reports (1896-1970), Vol. 55, No. 33 (Jun. 7, 1940), pp. 1005-1010.

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