In the past, the ancient practice of quarantine was often the only tool in the fight against infectious diseases like leprosy and bubonic plague. Even in today’s world of vaccines and antibiotics, quarantine still has a role, as Lizzie Enfield reveals.
Why we still need quarantine
Words by Lizzie Enfield
- In pictures
![An etching depicting the plague of Florence in 1348, with bodies piled high.](https://images.prismic.io/wellcomecollection/5633bfea-bf36-4d1b-bc6b-5da7332957cf_Sabatelli+etching+quarantine.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
The bodies of plague victims are piled high in Luigi Sabatelli’s etching of Florence during the Black Death of the 1340s. To prevent the disease from spreading, ships were isolated before passengers and crew could go ashore. They were secluded for 40 days, as it could take 37 days to die from the plague – only the lucky living would leave, while the infected would have died during quarantine. In fact, the word quarantine comes from the Italian quaranta giorni, meaning “40 days”.
![Watercolour painting depicts a medical officer examining a ship's crew for bubonic plague.](https://images.prismic.io/wellcomecollection/e621795f-9278-478b-81b1-1d43720ccc8a_medical+officer+quarantine+cropped.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
Bubonic plague wiped out an estimated third of Europe’s population during the 14th century. Recurring outbreaks continued across the world until the 19th century, and ships’ crews were regularly inspected on arrival at ports. A medical inspector would look for signs of plague by examining passengers’ tongues and feeling for bubonic swellings under their armpits. If there was evidence of disease, then ships would be quarantined as necessary.
![Photograph of a coloured etching from 1824 titled, Veduta del lazzeretto di S. Rocco. Pom Lapi scul. The etching shows a panoramic view of a harbour scene with small boats in the foreground.](https://images.prismic.io/wellcomecollection/976b30ba-5792-4535-8102-c046f4644580_EP001193_Quarantine_0002.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
In the early years of the plague, Venice took the lead in establishing quarantine stations for maritime travellers. These stations were ships permanently at anchor, isolated islands, or segregated buildings. The stations became known as lazarettos, as those emerging had metaphorically risen from the dead – as the biblical Lazarus did, having been restored to life by one of Christ’s miracles.
![Photograph of a machine used in a lazaretto in Venice, to disinfect letters and papers belonging to Plague Victims.](https://images.prismic.io/wellcomecollection/a8d19289-fb6b-4d9c-83b3-81c603b469b1_Plague+apparatus+quarantine.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
The possessions of those who left the lazarettos were disinfected to prevent the risk of the infection spreading. Special kinds of apparatus, like the device pictured, were used to treat items like coins, letters and clothing.
![Black and white etching of two lepers receiving food through a wall.](https://images.prismic.io/wellcomecollection/9835b929-b2ba-499e-8ec4-d333b38e70c8_lepers+quarantine.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
While the word quarantine originated in the 14th century, the practice of isolating infected patients goes much further back. As long ago as biblical times, people affected with leprosy were segregated from society.
![Side view of a Cholera Hospital in Oxford. The text reads: 'View of the Cholera Hospital with the Dispensary adjoining erected and fitted up on the Pepper Hills near the Oxford Canal'.](https://images.prismic.io/wellcomecollection/2581d6e7-e86d-4caa-a47f-e7b5b02cd39a_cholera+hospital+quarantine.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
Symptoms of ‘strangers’ disease’, also known as yellow fever, include black vomit and yellowing of the skin. Now it is known to be spread by mosquitoes, but in the 19th century it was believed that travellers and immigrants were the cause. This period also saw the arrival of Asiatic cholera, which led to the further use of quarantine as a method of preventing the spread of disease across the globe.
![Photograph of a watercolour depicting a coastal scene where a yellow quarantine flag raised on a ship anchored at sea some distance from a port, signals yellow fever is onboard.](https://images.prismic.io/wellcomecollection/1f73ee71-5b2c-4c1d-99b9-aac4cd79b429_EP001193_Quarantine_0003.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
On board ships and in ports flags were used to signal the presence of disease. The Yellow Jack, flown to denote yellow fever, also became a colloquial name for the disease itself. It is still used today to indicate a ship under quarantine measures. For example, a cruise ship that docked in St Lucia in the Caribbean was quarantined in May 2019 after a case of measles was confirmed.
![A Quarantine card to contain the spread of diphtheria reads: 'This card is not punishment it is protection to you and your neighbour'.](https://images.prismic.io/wellcomecollection/6f8a88e3-8b99-4a16-bb79-07e7ff19abdb_diptheria+card+quarantine.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
In the early 19th century diphtheria became one of the major causes of death. Its transmission was fuelled by increasingly crowded living conditions, which led to people being isolated in their homes or communities.
![Watercolour of a baby with a skin condition. Red bumps are spread across the face and body.](https://images.prismic.io/wellcomecollection/2f021fcc-34d9-44c9-9c63-903e7f6de405_smallpox+quarantine.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
The widespread use of antibiotics and vaccination rendered isolation through official quarantining largely redundant in the 20th century. However, quarantine is still practised with infectious diseases like chicken pox or measles, where it is recommended that people stay at home.
![Relief engraving based on a woodcut print from 1500. It shows patients in hospital beds, suffering from various kinds of infectious diseases.](https://images.prismic.io/wellcomecollection/04f710e2-5296-4dac-b0eb-7cb6bded09ae_emerging+infectious+diseases+quarantine.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
While the killer plague that led to the coining of the word ‘quarantine’ is no longer a threat to global populations, newly emerging infectious diseases such as Ebola continue to pose threats to human health on a mass scale. In the absence of effective treatments, quarantine remains an important tool in preventing deaths.
About the author
Lizzie Enfield
Lizzie Enfield is a journalist and regular contributor to national newspapers, magazines and radio. She has written five novels, and had her short stories broadcast on BBC Radio 4.