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Containing the Spread of Epidemics 

Containing the Spread of Epidemics
Chapter:
Containing the Spread of Epidemics
Author(s):

Andrew Cliff

and Matthew Smallman-Raynor

DOI:
10.1093/med/9780199596614.003.0001
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date: 19 July 2019

Using largely unknown maps in Italian state archives, this chapter shows how, from the establishment of the first quarantine station by the Republic of Ragusa (modern-day Dubrovnik) in1377, the states and principalities of Italy developed a sophisticated system of control to try to protect themselves from the ravages of plague. A cordon sanitaire existed around the Italian coast for five centuries, consisting of three elements: (i) an outer defensive ring of armed sailing boats in the Mediterranean and the Adriatic, (ii)a middle coastal ring of forts and observation towers, and (iii) an inner defensive ring of land-based cavalry. Health passports, and restrictions on travel and trade during plague epidemics were added to the surveillance system based on spies and the cordon sanitaire. The procedures developed were largely unsuccessful in their primary aim of preventing the spread of plague, a disease whose aetiology was then unknown. And yet it is clear that, apart from vaccination, unavailable at the time, the elements developed in northern Italy during the plague centuries form the nucleus of contemporary control systems for communicable diseases – surveillance, isolation, barriers to spread such as health passports, bans on travel, quarantine and forward planning. The system was largely forgotten when plague ceased to be a problem. It was reinvented north of the Alps from the middle of the nineteenth century when cholera pandemics swept the globe; then countries like England, Germany and France led the way, rather than Italy.

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