Quarantine

Quarantine, a medical term (from Italian: quaranta giorni, forty days) is the act of keeping people or animals separated for a period of time before, for instance, allowing them to enter another country. By doing this, it is possible to limit the risk of spreading disease.

For example, due to the risk of introducing rabies from Continental Europe, the United Kingdom used to require all dogs (and, indeed, most animals) introduced to the country to spend six months in quarantine at an HM Customs and Excise pound; this policy was abolished at the beginning of the 21st Century in favor of a scheme generally known as Pet Passports, where animals can avoid quarantine if they have documentation showing they are up to date on their appropriate vaccinations.

In the case of people, quarantine usually raises questions of civil rights, especially in cases of long confinement or segregation from society, such as that of Mary Mallon, a typhoid fever carrier. The first astronauts to visit the Moon were quarantined upon their return at a specially built Lunar Receiving Laboratory.

Quarantine is also used as a general term for blockading (such as the naval blockade which happened in the Cuban missile crisis in the 1960s) or for denying access systematically to a resource. In computer sciences, it is used to name the procedure of isolation of computer viruses into a special directory, until something can be done about it without danger of infecting other files in the disk.

For the science fiction novel by Greg Egan of the same name, see Quarantine (novel)

History

The word quarantine originates from a 40 day isolation of ships and people prior to entering the city of Dubrovnik (aka Ragusa). The isolation was practised as a measure of disease prevention and merchandise protection related to the plague (Black Death). The original document from 1377, which is kept in the Archives of Dubrovnik, states that before entering the city, newcomers had to spend 30 days in a restricted location (originally nearby islands) awaiting to see whether the symptoms of plague would develop. Later on, isolation was prolonged to 40 days and was called quarantine. According to estimations, between 1348 and 1359, the Black Death wiped out one quarter to one half of the entire population in Europe.

The plague was not the only disease for which quarantine was practised: we can mention the earlier isolation of lepers, the attempts to check the invasion of syphilis in northern Europe about 1490, the advent of yellow fever in Spain at the beginning of the 19th century and the arrival of Asiatic cholera in 1831. Venice took the lead in measures to check the spread of plague, having appointed three guardians of the public health in the first years of the Black Death (1348). The next record of preventive measures comes from Reggio in Modena in 1374. The first lazaret was founded by Venice in 1403, on a small island adjoining the city; in 1467 Genoa followed the example of Venice; and in 1476 the old leper hospital of Marseilles was converted into a plague hospital. The great lazaret of that city, perhaps the most complete of its kind, having been founded in 1526 on the island of Pomgue. The practice at all the Mediterranean lazarets was not different from the English procedure in the Levantine and North African trade. On the approach of cholera in 1831 some new lazarets were set up at western ports, notably a very extensive establishment near Bordeaux, afterwards turned to another use.

The plague had disappeared from England, never to return, for more than thirty years before the practice of quarantine against it was definitely established by an act of British Parliament of Queen Anne's reign (1710). The first act was called for, owing to an alarm, lest plague should be imported from Poland and the Baltics; the second act of 1721 was due to the disastrous prevalence of plague at Marseilles and other places in Provence; it was renewed in 1733 owing to a fresh outbreak of the malady on the continent of Europe, and again in 1743, owing to the disastrous epidemic at Messina. In 1752 a rigorous quarantine clause was introduced into an act regulating the Levantine trade; and various arbitrary orders were issued during the next twenty years to meet the supposed danger of infection from the Baltics. Although no plague cases ever came to England all those years, the restrictions on traffic became more amd more stringent (following the movements of medical dogma), and in 1788 a very oppressive Quarantine Act was passed, with provisions affecting cargoes in particular. The first year of the 19th century marked the turning-point in quarantine legislation; a parliamentary committee sat on the practice, and a more reasonable act arose on their report. In 1805 there was another new act, and in 1823-24 again an elaborate inquiry followed by an act making the quarantine only at discretion of the privy council, and at the same time recognizing yellow fever or other highly infectious disorder as calling for quarantine measures along with plague. The steady approach of cholera in 1831 was the last occasion in England of a thoroughgoing resort to quarantine restrictions. The pestilence invaded every country of Europe despite all efforts to keep it out. In England the experiment of hermetically sealing the ports was not seriously tried when cholera returned in 1849, 1853 and 1865-66. In 1847 the privy council ordered all arrivals with clean bills from the Black Sea and the Levant to be admitted to free pratique, provided there had been no case of plague during the voyage; and therewith the last remnant of the once formidable quarantine practice against plague may be said to have disappeared.

For a number of years after the passing of the first Quarantine Act (1710) the protective practices in England were of the most haphazard and arbitrary kind. In 1721 two vessels laden with cotton goods from Cyprus, then a seat of plague, were ordered to be burned with their cargoes, the owners receiving 23,935 as indemnity. By the clause in the Levant Trade Act of 1752 vessels for the United Kingdom with a foul bill (i.e. coming from a country where plague existed) had to repair to the lazarets of Malta, Venice, Messina, Leghorn, Genoa or Marseilles, to perform their quarantine or to have their cargoes sufficiently opened and aired. Since 1741 Stangate Creek (on the Medway) had been made the quarantine station at home; but it would appear from the above clause that it was available only for vessels with clean bills. In 1755 lazarets in the form of floating hulks were established in England for the first time, the cleansing of cargo (particularly by exposure to dews) having been done previously on the ships deck. There was no medical inspection employed, but the whole routine left to the officers of customs and quarantine. In 1780, when plague was in Poland, even vessels with grain from the Baltic had to lie forty days in quarantine, and unpack and air the sacks; but owing to remonstrances, which came chiefly from Edinburgh and Leith, grain was from that date declared to be a nonsusceptible article. About 1788 an order of the council required every ship liable to quarantine, in case of meeting any vessel at sea, or within four leagues of the coast of Great Britain or Ireland, to hoist a yellow flag in the daytime and show a light at the main topmast head at night, under a penalty of 200 pounds. After 1800, ships from plague-countries (or with foul bills) were enabled to perform their quarantine on arrival in the Medway instead of taking a Mediterranean port on the way for that purpose; and about the same time an extensive lazaret was built on Chetney Hill near Chatham at an expense of 170,000 ponds, which was almost at once condemned owing to its marshy foundations, and the materials sold for 15,000 pounds. The use of floating hulks as lazarets continued as before. In 1800 two ships with hides from Mogador (Morocco) were ordered to be sunk with their cargoes at the Nore, the owners receiving 15,000 pounds. About this period it was merchandise that was chiefly suspected: there was a long schedule of susceptible articles, and these were first exposed on the ships deck for twenty-one days or less (six days for each instalment of the cargo), and then transported to the lazaret, where they were opened and aired forty days more. The whole detention of the vessel was from sixty to sixty-five days, including the time for reshipment of her cargo. Pilots had to pass fifteen days on board a convalescent ship. The expenses may be estimated from one or two examples. In 1820 the Asia, 763 tons, arrived in the Medway with a foul bill from Alexandria, laden with linseed; her freight was 1475 and her quarantine dues 610. The same year the Pilato, 495 tons, making the same voyage, paid 200 quarantine dues on a freight of 106o. In 1823 the expenses of the quarantine service (at various ports) were 26,090, and the dues paid by shipping (nearly all with clean bills) 22,000. A return for the United Kingdom and colonies in 1849 showed, among other details, that the expenses of the lazaret at Malta for ten years from 1839 to 848 had been 53,553. From 1846 onwards the establishments in the United Kingdom were gradually reduced, while the last vestige of the British quarantine law was removed by the Public Health Act of 1896, which repealed the Quarantine Act of 1825 (with dependent clauses of other acts), and transferred from the privy council to the Local Government Board the powers to deal with ships arriving infected with yellow fever or plague, the powers to deal with cholera ships having been already transferred by the Public Health Act of 1875.

The British regulations of 9th November 1896 applied to yellow fever, plague and cholera. Officers of the Customs, as well as of Coast Guard and Board of Trade (for signalling), were empowered to take the initial steps. They certified in writing the master of a supposed infected ship, and detained the vessel provrisionally for not more than twelve hours, giving notice meanwhile to the port sanitary authority. The medical officer of the port boarded the ship and examined every person in it. Every person found infected was certified of the fact, removed to a hospital provided (if his condition allow), and kept under the orders of the medical officer. If the sick could be removed, the vessel remained under his orders. Every person suspected (owing to his or her immediate attendance on the sick) could be detained on board for 48 hours or removed to the hospital for a similar period. All others were free to land on giving the addresses of their destinations to be sent to the respective local authorities, so that the dispersed passengers and crew could be kept individually under observation for a few days. The ship was then disinfected, dead bodies buried at sea, infected clothing, bedding, etc., destroyed or disinfected, and bilge-water and water-ballast (subject to exceptions) pumped out at a suitable distance before the ship entered a dock or basin. Mails were subject to no detention. A stricken ship within 3 miles of the shore had to fly at the main mast a yellow and black flag borne quarterly from sunrise to sunset.

International Conventions

Since 1852 several conferences have been held between delegates of the European powers, with a view to uniform action in keeping out infection from the East and preventing its spread within Europe; all but that of 1897 were occupied with cholera. No result came of those at Paris (1852), Constantinople (1866), Vienna (1874), and Rome (1885), but each of the subsequent ones has been followed by an international convention on the part of nearly one-half of the governments represented. The general effect has been an abandonment of the high quarantine doctrine of constructive infection of a ship as coming from a scheduled port, and an approximation to the principles advocated by Great Britain for many years. The principal countrie which retained the old system at the time were Spain, Portugal, Turkey, Greece and Russia (the British possessions at the time, Gibraltar, Malta and Cyprus, being under the same influence). The aim of each international sanitary convention had been to bind the governments to a uniform minimum of preventive action, with further restrictions permissible to individual countries. The minimum specified by international conventios were very nearly the same as the British practice, which had been in turn adapted to continental opinion in the matter of the importation of rags.

The Venice convention of 1892 was on cholera by the Suez Canal route; that of Dresden, 1893, on cholera within European countries; that of Paris, 1894, on cholera by the pilgrim traffic; and that of Venice, in 1897, was in connection with the outbreak of plague in the East, and the conference met to settle on an international basis the steps to be taken to prevent, if possible, its spread into Europe.

One of the first points to be dealt with in 1897 was to settle the incubation period for this disease, and the period to be adopted for administrative purposes. It was admitted that the incubation period was, as a rule, a comparatively short one, namely, of some three or four days. After much discussion ten days was accepted by a very large majority. The principle of disease notification was unanimously adopted. Each government had to notify to other governments on the existence of plague within their several jurisdictions, and at the same time state the measures of prevention which are being carried out to prevent its diffusion. The area deemed to be infected was limited to the actual district or village where the disease prevailed, and no locality was deemed to be infected merely because of the importation into it of a few cases of plague while there has been no diffusion of the malady. As regards the precautions to be taken on land frontiers, it was decided that during the prevalence of plague every country had the inherent right to close its land frontiers against traffic. As regards the Red Sea, it was decided after discussion that a healthy vessel could pass through the Suez Canal, and continue its voyage in the Mediterranean during the period of incubation of the disease the prevention of which is in question. It was also agreed that vessels passing through the Canal in quarantine might, subject to the use of the electric light, coal in quarantine at Port Said by night as well as by day, and that passengers might embark in quarantine at that port. Infected vessels, if these carry a doctor and are provided with a disinfecting stove, have a right to navigate the Canal, in quarantine, subject only to the landing of those who were suffering from plague.

References

External links

• Ayliffe GAJ, English MP, Hospital infection, From Miasmas to MRSA, Cambridge Univ Press, 2003 (http://assets.cambridge.org/052181/9350/sample/0521819350ws.pdf)

• Frati P: Quarantine, trade and health policies in Ragusa-Dubrovnik until the age of George Armmenius-Baglivi. Med Secoli. 2000;12(1):103-27. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11624707&dopt=Abstract)

• Buklijaš T, Fatović-Ferenčić S: Medico-legal Practices in Medieval Dubrovnik. Croat Med J. 2004;45:220-225. (http://www.cmj.hr/2004/4502/18_Buklijas.pdf)

• Emerging Infectuous Diseases, Vol.8, No.1 (http://www.cdc.gov/ncidod/EID/vol8no1/cover.htm)

• History of quarantine (from PBS NOVA) (http://www.pbs.org/wgbh/nova/typhoid/quarantine.html)da:Karantæne

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