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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: 15 July 2020

  1. 1.1 Introduction [link]

  2. 1.2 Disease Control in Italy: The Plague Centuries, 1342–1851 [link]

  3. 1.3 Prato, 1630 [link]

  4. 1.4 Models of Control [link]

    • Spatial Mass Action Models [link]

    • Barriers to Spread [link]

    • Sicily, 1743: The Plague of Messina [link]

  5. 1.5 Conclusion [link]

    • Appendix 1.1: Map Sources [link]

1.1 Introduction

From the time humans first lived in groups and communicable diseases of humans began to emerge, fear of the spread of infection from one person to another, from one community to another, from one country to another, and from one continent to another grew. And means were sought to contain such spread. The fear of pestilential spread found its way into early writing – for example, the biblical Pharonic plagues of Moses which selectively killed the firstborn of Egypt (Exodus, 12, 13); being spared of pestilence (1 Chronicles 22; Mark 5, 34); and the pale horse of Revelation 6 with dominion over a quarter of the earth and the power to kill inter alia by pestilence.

In medieval times, mystical writing about pestilence (one of the “wages of sin”) was allied with practical methods to control the geographical diffusion of communicable disease. This reached a first zenith in Italy during the five plague centuries beginning with the Black Death of 1346–52. In the modern era, medical progress led to a second zenith by enabling the physical controls on disease spread used from early times, such as quarantine and barriers to movement, to be complemented by prophylactic methods and education. The first generally successful vaccinations were employed by Edward Jenner at the end of the eighteenth century to control the spread of smallpox (Figure 1.1). The medical developments of the twentieth century ushered in an apparently golden era of communicable disease prevention by vaccination against the great epidemic killing diseases of history. To smallpox, control was added for infections like diphtheria, whooping cough, scarlet fever, measles, mumps, rubella and poliomyelitis so that, by the last quarter of the twentieth century, the geographical spread of epidemic communicable diseases appeared largely to have been achieved. But it proved a false dawn as epidemics of new infections like HIV (human immunodeficiency virus) and SARS (severe acute respiratory syndrome) emerged alongside the growing drug resistance of others like tuberculosis to refocus the debate on how to control the geographical spread of communicable or infectious diseases.

Figure 1.1 Vaccination. Edward Jenner (1749–1823), whose general practice was located in Berkeley, Gloucestershire, is generally credited with the discovery in 1796 of cowpox vaccination to provide protection against smallpox. But it was in fact a Dorset farmer, Benjamin Jesty, who was the first person recorded as having inoculated a person with cowpox matter in order to protect against smallpox – the procedure subsequently known as vaccination. He carried out this procedure on his wife and sons in 1774, some twenty years before Edward Jenner independently performed the same operation in Gloucestershire. It was, however, certainly Jenner who made the procedure public and widely available to the population of his local area at the Temple of Vaccinia in Berkeley. The method was initially regarded with scepticism in many quarters as James Gillray’s (1802) cartoon makes clear. It shows Jenner among patients at the Smallpox and Inoculation Hospital, St Pancras, London, vaccination point in hand, and a tin of cowpox held for him by a young ruffian. Recipients of the brew could expect to grow bits of cows. Notice also the use of “OPENING MIXTURE” on those queuing for vaccination to make it more efficacious!

Figure 1.1
Vaccination. Edward Jenner (1749–1823), whose general practice was located in Berkeley, Gloucestershire, is generally credited with the discovery in 1796 of cowpox vaccination to provide protection against smallpox. But it was in fact a Dorset farmer, Benjamin Jesty, who was the first person recorded as having inoculated a person with cowpox matter in order to protect against smallpox – the procedure subsequently known as vaccination. He carried out this procedure on his wife and sons in 1774, some twenty years before Edward Jenner independently performed the same operation in Gloucestershire. It was, however, certainly Jenner who made the procedure public and widely available to the population of his local area at the Temple of Vaccinia in Berkeley. The method was initially regarded with scepticism in many quarters as James Gillray’s (1802) cartoon makes clear. It shows Jenner among patients at the Smallpox and Inoculation Hospital, St Pancras, London, vaccination point in hand, and a tin of cowpox held for him by a young ruffian. Recipients of the brew could expect to grow bits of cows. Notice also the use of “OPENING MIXTURE” on those queuing for vaccination to make it more efficacious!

Source: Wellcome Library, London.

It is this topic – controlling the spatial or geographical diffusion of infectious diseases – which forms the subject of this book. Many are capable of causing epidemics with widespread public health, demographic, social and economic consequences. As we shall see, there is a large literature on aspects of epidemic control, but very little of it is geographical. And yet control is an inherently geographical problem with surveillance at its core. In England, the importance of the spatial dimension and the need for surveillance was incisively summarised at the end of the nineteenth century by Tatham (1888, p. 403):

Again and again we have had to complain of the importation of infection into Salford [England] from non-notification outside districts immediately contiguous to our boundaries…[E]ven between towns which possess powers for the compulsory notification of infectious disease, there exists at present no organization by which one sanitary authority may receive timely warning of the presence of infectious disease in the district of a neighbouring authority.

If epidemic diseases did not spread from person to person, and infected individuals move from area to area, containment would be relatively straightforward. But diseases and people do move. In the twenty-first century, mass airline travel has ensured that all inhabited points of the globe are within a day’s flying time – within the incubation period of all communicable diseases of public health importance – and so, as W.H. Auden’s 1938 poem, Gare du Midi, succinctly summarises, it is possible for the seeds of an epidemic silently to arrive in a new geographical location unwitnessed until the damage is done. To this element of spread we can add the increasing tropicalisation of the human population as global warming increases the spatial extent of many diseases and grows the geographical range of “tropics” north and south from 23.5° North and South, potentially exposing populations in previously temperate zones to a spectrum of new infections.

Contemporary geographical disease control systems employ several elements: surveillance, isolation or quarantine, vaccination, and forecasting models of spread to inform intervention strategies. This book devotes a single chapter to each of these elements. Many of the concepts underpinning these themes were developed into an interlocking system by the states and cities of Italy from the thirteenth century in an attempt to control the spread of bubonic plague to and within Italy. In this chapter, the development of the Italian system is described. Then the system which was developed is cast into a theoretical framework to underpin the individual chapters on surveillance, quarantine, vaccination and forecasting which comprise the remainder of the book.

1.2 Disease Control in Italy: The Plague Centuries, 1342–1851

After the great pandemic of Black Death which affected Europe for some seven years from 1346, plague became endemic in Europe (Hirsch, 1883; Simpson, 1905; Pollitzer, 1954). Italy was entrained in 1347–8, with epidemics continuing there over the next four and a half centuries (Figures 1.2 and 1.3). The epidemic history of Italy in this period is reviewed in detail by Corradi (1865–94), while summary overviews of the major outbreaks of plague and plague-like disease are provided by Biraben (1975–76) and Scott and Duncan (2001). To these general surveys can be added many local investigations of plague mortality (Carmichael, 1986, [link]). Illustrative are the studies of Carmichael (1991) and Zanetti (1976) on fifteenth- and sixteenth-century Milan, Morrison, et al. (1985) and Carmichael (1986) on fifteenth-century Florence, Ell (1989) on seventeenth-century Venice and Cipolla (1981a) on seventeenth-century Pistoia. As described in these and similar works, the repeated outbreaks of plague deeply affected culture, society and economy at all levels. In response to the threat posed by plague visitations, three main groupings of states emerged (Scott and Duncan, 2001, p. 303): (i) the city states of the north (particularly Venice, Milan and Genoa), wealthy and jealous of each other; (ii) the Santa Sede (Holy See/Papal States); and (iii) in the south two very different and poor regions, the Kingdoms of Naples and Sicily (eventually the Kingdom of the Two Sicilies).

Figure 1.2 Plague outbreaks in Italy, 1347–1816. Annual time series of number of localities reporting plague. The generalised epidemics of 1348, 1383, 1457, 1478, 1522–28, 1577, 1630 and 1656 stand out from the annual background of 4–5 outbreaks which occurred in one place or another throughout the period.

Figure 1.2
Plague outbreaks in Italy, 1347–1816. Annual time series of number of localities reporting plague. The generalised epidemics of 1348, 1383, 1457, 1478, 1522–28, 1577, 1630 and 1656 stand out from the annual background of 4–5 outbreaks which occurred in one place or another throughout the period.

Source: data in Biraben (1975–76, Annexes III and IV, pp. 363–74, 394–400).

Figure 1.3 Geographical distribution of number of recorded plague outbreaks in Italy, 1340–1820. (A) 1340–1450. (B) 1451–1550. (C) 1551–1650. (D) 1651–1820. Outbreaks declined in number and became more widely dispersed spatially over the period.

Figure 1.3
Geographical distribution of number of recorded plague outbreaks in Italy, 1340–1820. (A) 1340–1450. (B) 1451–1550. (C) 1551–1650. (D) 1651–1820. Outbreaks declined in number and became more widely dispersed spatially over the period.

Source: data in Biraben (1975–76, Annexe IV, pp. 394–400)

It was the northern group of states which led the fight against the disease. Despite its (then) unknown aetiology, these states gradually evolved a system of public health which, by the middle of the seventeenth century, had reached a high degree of sophistication. The northern Italian focus of this evolution was driven by the position of Italy at the interface of Europe and Asia, its location on arms of the Silk Road, and the dependence of the great republics like Venice and Genoa upon trade with Asia for their prosperity, factors which combined to ensure that importation of the plague, especially by ships returning from the Levant, was an ever-present threat. Similar developments to those in northern Italy took place north of the Alps but remained at a much more primitive level – as they did in Italy south of the Dukedom of Tuscany (Cipolla, 1981a, [link][link]).

The system which evolved was based upon special Magistracies which, while they combined legislative, judicial and executive powers in all matters pertaining to the public health, had as their prime focus prevention of the plague. By the middle of the sixteenth century, all major cities of northern Italy had permanent Magistracies, reinforced in times of emergency by health boards set up in minor towns and rural areas. All boards were subordinate to and directly answerable to the central Health Magistracies of their respective capital cities (Cipolla, 1981a, [link]). The Magistracies stressed prevention rather than cure, and out of their organisational genius came the ideas of surveillance and quarantine that have persisted to the present day. The nature and operation of Italian plague defences has attracted a specialised literature (see Carmichael, 1986, [link]). In the English language, the volumes by Cipolla (1973, 1981a, b) are well known, while Italian-language studies and reports in relation to such cities as Florence (Ciofi, 1984), Milan (Beltrami, 1882; Decio, 1900; Bottero, 1942) and Venice (Preto, 1978; del Fiumi, 1981) are illustrative of local investigations. A recent study by Konstantinidou, et al. (2009) adds further context for the discussion which follows.

Surveillance

Underpinning the system was surveillance and inter-state communication. During the sixteenth and seventeenth centuries, the Health Magistracies of the capital cities of the republics and principalities of Italy north of the Santa Sede established the custom of regularly informing each other of all news they gathered on health conditions prevailing in various parts of Italy, the rest of Europe, North Africa, and the Middle East. For example, Florence ‘corresponded’ regularly with Genoa, Venice, Verona, Milan, Mantua, Parma, Modena, Ferrara, Bologna, Ancona and Lucca. The frequency of the correspondence with each of these places ranged from one letter every two weeks in periods of calm to several letters a week in times of emergency (Cipolla, 1981a, [link]).

Spies and later official observers were also present in the major cities who reported back to their employers on the state of health in the various republics and principalities. But it was the great plague epidemic of 1652 which ultimately led to agreed, coordinated and enforced action among the north Italian states in a Capitolazione (Convention) between Florence, Genoa and the Santa Sede. The Convention bound the three powers to common practices and health measures in the principal ports of Genoa, Leghorn (Livorno) and Civitavecchia. Each state agreed to allow the other two to station one representative of their respective health boards in the main harbour – a forerunner of “international controls and the voluntary relinquishment of discretionary powers by fully sovereign states in the matter of public health” (Cipolla, 1981a, [link]). The concerto between Tuscany and Genoa came rapidly to pass, but attempts to bring in the state groupings (ii) and (iii) mentioned earlier (the Santa Sede and Naples) proved meagre. Even the concerto between Tuscany and Genoa collapsed a few years later, but it was a remarkable early attempt at international health collaboration not repeated for 200 years until the international control of the great nineteenth-century cholera pandemics became paramount (Huber, 2006).

When contagious disease was uncovered anywhere by a particular Magistracy, a proclamation of ban (when the presence of communicable disease was positively ascertained) or suspension (precaution because there was legitimate suspicion of disease) was issued. Bans were long term, suspensions short term. Bans and suspensions were used to denote the interruption of regular trade and communication. With banishment and suspension, no person, boat, merchandise or letter could enter the state issuing the order except at a few well-specified ports or places of entrance where quarantine stations were set up. At the stations, incoming people, boats and merchandise were subject to quarantine and disinfection even if they carried health certificates issued at the point of departure (Figure 1.4). The health certificates were the seventeenth- and eighteenth-century equivalents of the twentieth-century international vaccination certificates, certifying that travellers and boats were free of disease. The authorities also reserved the right to refuse access to anything or anybody from banished areas – even, if necessary, to the quarantine stations. People attempting to violate the ban or enter the territory of the banishing state were commonly executed (Figure 1.5).

Figure 1.4 Certificates issued at times of plague. (Upper, left to right) Bologna, 1613, poster proclaiming no contact, on pain of death, with people or animals from Cologne, Düsseldorf or Vratislavia where there was plague; Ferrara, 1679, poster proclaiming restrictions on trade to help combat the transmission of plague; Ferrara, 1682, poster stating health passes to be introduced in six days. (Lower, left to right) travel documents issued by Naples and Venice. Left and centre are two health passports. The document on the left, dated 1632 and measuring 35×25 cm, is embossed with coats of arms and a panorama of Naples. It was issued to the captain of the fellucha (a type of boat) named Santa Maria del Rosario, which was sailing from Naples to Civitavecchia, the port of Rome, with five sailors on board. Their names are listed at the end of the certificate. It declares Naples to be free of all infectious disease, and asks for unrestricted and secure pratique (prattica: a licence to deal with a port after quarantine or on producing a clean bill of health). Nearly a hundred years later (1713) and the health passport for Venice (centre) appears essentially the same as that for Naples. The document on the right, measuring 16×12 cm and embossed with the arms of the city of Naples, was given in plague periods to each traveller from the port of Naples at embarkation. It declares the city to be healthy and free of all morbid contagions. It also declares that it is safe to trade and negotiate with the bearer without fear of infection. The almost illegible handwriting gives the date (30 June or July 1632), the name and a description of the bearer, his destination, and the signatures of the four representatives of the city authorities. The anonymous source author (p. 32), interprets the script as Giovanni Angelo Baucano, of the Greek Tower (de la Torre dello Greco barely recognisable at the end of line 1), age 48 (de anni 48, line 2), with a dark chestnut moustache (castagno, middle of line 2) and a mole on the upper left cheek, travelling to Civitavecchia (line 3). The signatories are: Francesco Caracciolo, Delio Capece, Giov. Battista d’Alessandro, and Fabio di Ruvo. Such certificates were issued to try to guarantee free passage and continuance of travel in the face of bans and suspensions.

Figure 1.4
Certificates issued at times of plague. (Upper, left to right) Bologna, 1613, poster proclaiming no contact, on pain of death, with people or animals from Cologne, Düsseldorf or Vratislavia where there was plague; Ferrara, 1679, poster proclaiming restrictions on trade to help combat the transmission of plague; Ferrara, 1682, poster stating health passes to be introduced in six days. (Lower, left to right) travel documents issued by Naples and Venice. Left and centre are two health passports. The document on the left, dated 1632 and measuring 35×25 cm, is embossed with coats of arms and a panorama of Naples. It was issued to the captain of the fellucha (a type of boat) named Santa Maria del Rosario, which was sailing from Naples to Civitavecchia, the port of Rome, with five sailors on board. Their names are listed at the end of the certificate. It declares Naples to be free of all infectious disease, and asks for unrestricted and secure pratique (prattica: a licence to deal with a port after quarantine or on producing a clean bill of health). Nearly a hundred years later (1713) and the health passport for Venice (centre) appears essentially the same as that for Naples. The document on the right, measuring 16×12 cm and embossed with the arms of the city of Naples, was given in plague periods to each traveller from the port of Naples at embarkation. It declares the city to be healthy and free of all morbid contagions. It also declares that it is safe to trade and negotiate with the bearer without fear of infection. The almost illegible handwriting gives the date (30 June or July 1632), the name and a description of the bearer, his destination, and the signatures of the four representatives of the city authorities. The anonymous source author (p. 32), interprets the script as Giovanni Angelo Baucano, of the Greek Tower (de la Torre dello Greco barely recognisable at the end of line 1), age 48 (de anni 48, line 2), with a dark chestnut moustache (castagno, middle of line 2) and a mole on the upper left cheek, travelling to Civitavecchia (line 3). The signatories are: Francesco Caracciolo, Delio Capece, Giov. Battista d’Alessandro, and Fabio di Ruvo. Such certificates were issued to try to guarantee free passage and continuance of travel in the face of bans and suspensions.

Sources: (Lower, left and right) Ministero dell’Interno, Direzione Generale Della Sanità Pubblica, Napoli (1910, Plates II and III following [link]). Remainder: Wellcome Library, London

Figure 1.5 The plague in Rome, 1656. Extracts from G.G. de Rossi’s 1657 three-part etching of episodes of the 1656 outbreak of the plague in Rome. (A) Guarded river crossing point (41) to ensure boats did not land illegally with a sentry (42) at his post. (B) Execution of persons who broke the quarantine rules.

Figure 1.5
The plague in Rome, 1656. Extracts from G.G. de Rossi’s 1657 three-part etching of episodes of the 1656 outbreak of the plague in Rome. (A) Guarded river crossing point (41) to ensure boats did not land illegally with a sentry (42) at his post. (B) Execution of persons who broke the quarantine rules.

Source: World Health Organization Library, Geneva.

Cordon Sanitaire

The regular attacks by Turks, Barbary Coast and Corsican pirates from the Middle Ages onwards upon the coastlines of the states and towns of Italy meant that there existed an extensive system of coastal defensive towers, castles and forts which formed the basis of a maritime cordon sanitaire in time of plague. The sanitary observation posts encircled the entire Italian coastline. Some of the maps, generally fugitively catalogued and largely unknown, showing the locations of these posts have survived (Figure 1.6). They are described in Cliff, Smallman-Raynor and Stevens (2009) upon which this subsection is based. In Figure 1.6, the strings of posts are denoted by the solid lines. The identity numbers correspond with the numbered list of sources given in Appendix 1.1.

Figure 1.6 Cordon sanitaire and containment of the plague in Italy by the eighteenth century. Geographical locations of surviving maps showing observation posts which comprised the defensive isolation ring maintained around Italy against the plague. Map extents are shown by boxes, and strings of posts by heavy lines. The identity numbers correspond with the sources listed in Appendix Appendix 1.1: Map Sources1.1.

Figure 1.6
Cordon sanitaire and containment of the plague in Italy by the eighteenth century. Geographical locations of surviving maps showing observation posts which comprised the defensive isolation ring maintained around Italy against the plague. Map extents are shown by boxes, and strings of posts by heavy lines. The identity numbers correspond with the sources listed in Appendix 1.1.

Source: Cliff, Smallman-Raynor and Stevens (2009, Figure 5, p. 207)

The cordon comprised two elements: (i) in both the Adriatic and the Mediterranean, armed sailing boats (feluccas, trabaccoli, baragozzi) to prevent illegal landings; and (ii) coastal observation towers and sentry boxes manned by armed infantry who stopped and recorded people and merchandise passing through the post. In addition, so-called “flying corps” of cavalry were deployed in some locations in the rear of the observation posts. The role of the flying corps was to act as a rapid response force, mopping up sources of infection which penetrated the outer rings of boats and observation posts. Finally, within the overall ring, individual defensive quarantine rings were constructed from time to time along land borders and around individual towns as necessary to keep out local disease threats.

The observation posts were constructed within sighting distance of each other; communication between posts was primarily by sephamore (daylight) and beacon (night) signals. The reporting system was hierarchical: local observation postsdistrict central command postregional reporting centre. Some of the maps give an indication of the manning – around 2–5 soldiers per observation post, with periodic forts of around 30–50 men. Observation posts not only recorded the traffic passing, but also tried to prevent illegal passage so that ships, goods and travellers were routed into fixed quarantine stations.

The Northern States

Venice

Because of its maritime supremacy and trading connections, the Venetian Republic was visited by plague at regular intervals over nearly five centuries. Accordingly, the Republic established an extensive ring of sanitary guard or signal posts around its borders from an early date. Figure 1.7 illustrates an extract from one of the surviving maps around Monfalcone. The individual posts appear as tents (see added enlarged inset in bottom left corner), while the 76 casselli (signal posts) are named in the entablature. Figure 1.8 illustrates the frontier ring erected along the borders of the territory of Friuli in 1713 at times of epidemics. This print shows the guard posts for the infantry (appostamenti di infanteria) in the foreground, as well as men at arms and supporting cavalry. The guard posts were designed primarily to prevent the arrival of plague overland. The Ottoman Dominions were regarded as the main threat. On arrival, persons and goods suspected of carrying disease were confined in one of the city’s two lazarettos for a statutory quarantine period of 40 days (see ‘Quarantine and Isolation’).

Figure 1.7 Sanitary guard posts of Monfalcone. Map of the territory of Monfalcone between the lake of Pietra Rossa and the River Isonzo, showing the towns, posts and sanitary guard huts at the border with the Granducale (Tuscany).

Figure 1.7
Sanitary guard posts of Monfalcone. Map of the territory of Monfalcone between the lake of Pietra Rossa and the River Isonzo, showing the towns, posts and sanitary guard huts at the border with the Granducale (Tuscany).

Source: Appendix 1.1 (8).

Figure 1.8 Sanitary guard lines in Friuli. Acquatint drawing of the infantry and cavalry posts erected along the borders of the territory of Friuli in times of epidemics.

Figure 1.8
Sanitary guard lines in Friuli. Acquatint drawing of the infantry and cavalry posts erected along the borders of the territory of Friuli in times of epidemics.

Source: Appendix 1.1 (9).

Genoa

The defensive quarantine ring, as well as the location of other infrastructure used to protect the public health of the Republic of Genoa, was mapped in a remarkable atlas by Matteo Vinzoni in 1758 (Appendix 1.1 (13)). In the first half of the eighteenth century, Liguria was divided into 36 health districts, each over per district, Vinzoni charted the locations of the hospitals, lazarettos and sanitary (health) observation posts serving each district. The manning information recorded by Vinzoni varied by health district and is of three types: (i) the complement by day and night at each of the guard posts; (ii) post complement plus information on the military support in the district; (iii) simple lists of the post names.

Archival documents indicate how the system operated. Regular armed soldiers were assigned to the posts, supported by men from the local area on a rotation basis. Some posts were manned day and night while others were manned only at night. Nocturnal manning was more intensive because inter-post communication and observation was restricted by darkness. Logs were kept at each post of the visitors passing through the post.

Figure 1.9 illustrates the map for the health district of San Pier d’Arena which comprised the subdistricts of Cornigliano and Sampierdarena [sic]. The plate shows that 10 smaller observation posts (guardia) were supported by a castle (castello) (site 9). Some of the accompanying text details the night patrols. The two for San Pier have been added to Figure 1.9. The guard posts of the two subdistricts were visited by three patrols nightly. Each patrol consisted of two men from the castle who had been collected by a patrol leader from each subdistrict. The first patrol ran between 0100–0500 hours, the second between 0500–0900 hours and the third from 0900–1300 hours. At the conclusion of each patrol, the guard was returned to the castle by the patrol leader. This intensity was judged sufficient for the number of visitors to San Pier (90 per day) (source: Appendix 1.1 (13, [link])).

Figure 1.9 Sanitary guard posts of Genoa. Extract from the map of the health district of San Pier d’Arena from Vinzoni’s sanitary atlas of Genoa (1758) showing the guard posts (guardia) along the coast, along with the routes followed by the night patrols (added). The enlargement shows that Vinzoni numbered the posts serially on his maps, and this was linked to an account of the manning and nature of each guard post in his Atlas. See text for examples.

Figure 1.9
Sanitary guard posts of Genoa. Extract from the map of the health district of San Pier d’Arena from Vinzoni’s sanitary atlas of Genoa (1758) showing the guard posts (guardia) along the coast, along with the routes followed by the night patrols (added). The enlargement shows that Vinzoni numbered the posts serially on his maps, and this was linked to an account of the manning and nature of each guard post in his Atlas. See text for examples.

Source: Appendix 1.1 (13, 1758, [link][link]).

The Santa Sede (Holy See/Papal States)

Two maps exist showing the cordon sanitaire for the Santa Sede, one for the Mediterranean coast, and one for the Adriatic coast including the land border with the Kingdom of Naples.

Mediterranean coast (Appendix 1.1 (14))

This map (Figure 1.10) plots and tabulates the sanitary, military and customs posts along the 226 km Mediterranean coast of the Santa Sede from the border with the Grand Duchy of Tuscany to Graticciare on the border with the Kingdom of Naples. Operationally, the coast was divided into four Divisions, Civitavecchia (12 observation posts), Fiumicino (5 posts), Porto d’Anzio (7 posts) and Terracina (10 posts), at average spacing of 6.6 km.

Figure 1.10 Sanitary guard posts of the Mediterranean coast of the Papal States. The whole map appears as the inset. The enlarged extract details the location of each sanitary post, inter-post distances, condition of the route, rivers and bridges between each post, and the distances from posts to reporting centres, all geared to produce rapid surveillance and reporting of infringements.

Figure 1.10
Sanitary guard posts of the Mediterranean coast of the Papal States. The whole map appears as the inset. The enlarged extract details the location of each sanitary post, inter-post distances, condition of the route, rivers and bridges between each post, and the distances from posts to reporting centres, all geared to produce rapid surveillance and reporting of infringements.

Source: Appendix 1.1 (14).

Adriatic coast, Ravenna to Ascoli (Appendix 1.1 (15))

The map of this 80 km section of coast was divided into four geographical Divisions, each under the command of an army captain and his adjutant. The extract in Figure 1.11 (figure located in the colour plate section) shows the First Division from Ancona to Ascoli, and the Fourth Division (the land border with the Kingdom of Naples). The Divisions were divided into Sections (for example, 10 in the case of the First Division). Within each Section, lookout posts (serially numbered 1, 2,…within each Division) were established at regular intervals, approximately 0.33 km apart. Nearly all Sections had their own sanitary officer (location marked with an asterisk). There was a reporting hierarchy; Section lookout posts reported to a central lookout post occupied by the Commander of the Section and the Sanitary Superintendent. In their turn, the central lookout posts returned their data to Divisional reporting lookout posts which were responsible for transmitting the information to the Commander-in-Chief of the cordon sanitaire (Captain Guiseppe Vaselli), whose seal appears in the lower right corner of Figure 1.11.

Figure 1.11. Sanitary guard posts of the Adriatic coast of the Papal States. Divisions 1 and 4 of the cordon sanitaire of the Adriatic coast of the Santa Sede, 1816. See text for a description of the map elements.

Figure 1.11.
Sanitary guard posts of the Adriatic coast of the Papal States. Divisions 1 and 4 of the cordon sanitaire of the Adriatic coast of the Santa Sede, 1816. See text for a description of the map elements.

Source: Appendix 1.1 (15).

The map also gives the military complement of each post (italic script on the seaward side of each bar). In addition to the infantry, flying corps (cavalry; cf. Figure 1.8 for Venice) were based in Ascoli to support the lookout posts in maintaining the cordon along the land border with the Kingdom of Naples. The flying corps operated an offensive containment policy. The map includes a summary table of the manning of the cordon – for the four Divisions, nearly 1,900 men. Armed sailing boats (trabaccoli) cruised the Adriatic and completed the protection ring (one appears in Figure 1.11). The area around Ravenna (Section 5 of the Third Division) must have been especially vulnerable, adjacent as it was to the great trading city of Venice, and with many inland rivers. Here the quarantine defences were reinforced by squadrons of 4–6 small sailing boats (baragozzi). Thus consistent with the system around Venice, the surveillance ring was three layers deep; an outer ring of armed boats in the Adriatic, a middle ring of coastal observation posts manned by infantry, and an inner ring of what in modern terms would be called a rapid response force of cavalry providing additional offensive cover – here at the land frontier with the Kingdom of Naples.

Quarantine and Isolation

Once plague entered an area, quarantine and isolation were deployed to limit spread. The first rudimentary steps in the eastern Mediterranean area were taken in 1377 when the Republic of Ragusa, a former Venetian colony on the Dalmatian Coast, instituted a legal system for the quarantining of visitors from plague-affected areas (Stuard, 1973; Kiple, 1993, [link]; Frati, 2000; Sehdev, 2002). The Republic was also the location of the first permanent health office. As described in Frati (2000) and Palmer (1978, p. 208), the Ragusean approach was a compromise between the (potentially) complete blockade of human and commercial intercourse generally practised in western Europe in plague periods and the complete absence of intervention in the Ottoman east. The Ragusean system of regulation aimed to protect business in Ragusa, one of the great medieval maritime trading republics in the region.

As regards the Italian states, maritime quarantine was pioneered by the Venetian administration with the establishment of a lazaretto on the island of Santa Maria di Nazareth in 1403 (Simpson, 1905; Hirst, 1953; Gensini, et al., 2004). Trying to prevent plague arriving by sea is described in a mid-eighteenth-century booklet by Venice’s Magistrato della sanità (1752):

Experience has shewn [sic], that in the Ottoman Dominions, the Plague is never utterly extinct: Hence it is an immutable Law with the Magistrate of the Office of Health, to consider the whole Extent of the Ottoman Dominions and every State dependent on it, as always to be suspected to be in an infected Condition, to such a Degree, as not to receive, in any Part of the Dominions of the Republick [Venice], either confining to or commercing with them, any Persons, Merchandizes, Animals, or any other Thing coming from thence, without the necessary Inspection of the Office of Health, and the previous purifications

Magistrato della sanità, 1752, [link]

Although the Ottoman Dominions were perceived as the prime risk, the same procedures were followed for “every Vessel, coming from any Part of the World, that is either infected, or suspected to be so” (Magistrato della sanità, 1752, [link]). Vessels were normally expected to stop at Istria to take on board a pilot, or were towed up to Venice. Spies were maintained on the high tower of San Marco to watch for approaching vessels. The Magistrate sent one of his 60 Guardians to meet the ship which was moored in distant canals up to 25 km from the city according to the level of perceived risk. Ships were guarded throughout the quarantine period. They were unloaded of goods and passengers and both were dispatched to one of the city’s two lazarettos. Generally, unless they were afflicted with full-blown plague, new arrivals were confined in the Nuovo Lazzaretto (New Lazaretto). The unfortunate creatures suffering from full plague either on arrival or during quarantine were dispatched to Lazzaretto Vecchio (the Old Lazaretto); see Figure 1.12 for locations and descriptions. Only when the ship had been fully unloaded did the statutory 40 day quarantine period begin.

Figure 1.12 Lazarettos of Venice. Location map of the Old (Lazzaretto Vecchio) and New (Lazzaretto Nuovo) Lazarettos of Venice. The engravings show the ground floor plan of Lazzaretto Vecchio and a prospect of the lazaretto from the northwest corner. Lazzaretto Vecchio was established in 1403 about 2 km from Venice on a small island then known as Santa Maria di Nazareth, close to modern Lido. Lazzaretto Nuovo was established in 1468 on the island then known as Vigna Murada, separated by a navigable channel from the southern tip of the island of Sant’ Erasmo, about 3 km from Venice. It occupied a strategic location at the entrance to the Venetian lagoon from the Adriatic and, when visited by John Howard in 1786, was used primarily to quarantine Turks, soldiers and crews of plague-infected ships (Howard, 1791, 1.3 Prato, 1630p. 11). By decree, ships, passengers and goods were isolated for a limited period to allow for the manifestation of any disease and to dissipate imported infection. Originally the period was 30 days, trentina, but this was later extended to 40 days, quarantina. The choice of this period is said to be based on the period that Christ and Moses spent in isolation in the desert.

Figure 1.12
Lazarettos of Venice. Location map of the Old (Lazzaretto Vecchio) and New (Lazzaretto Nuovo) Lazarettos of Venice. The engravings show the ground floor plan of Lazzaretto Vecchio and a prospect of the lazaretto from the northwest corner. Lazzaretto Vecchio was established in 1403 about 2 km from Venice on a small island then known as Santa Maria di Nazareth, close to modern Lido. Lazzaretto Nuovo was established in 1468 on the island then known as Vigna Murada, separated by a navigable channel from the southern tip of the island of Sant’ Erasmo, about 3 km from Venice. It occupied a strategic location at the entrance to the Venetian lagoon from the Adriatic and, when visited by John Howard in 1786, was used primarily to quarantine Turks, soldiers and crews of plague-infected ships (Howard, 1791, [link]). By decree, ships, passengers and goods were isolated for a limited period to allow for the manifestation of any disease and to dissipate imported infection. Originally the period was 30 days, trentina, but this was later extended to 40 days, quarantina. The choice of this period is said to be based on the period that Christ and Moses spent in isolation in the desert.

Source: ground floor plan of Lazzaretto Vecchio from Howard (1791, Plate 12); prospect is a mid-eighteenth-century copper engraving by the Venetian artist, Giuseppe Filosi. The ground floor plan has been distorted to conform with the prospect.

The Old and New Lazarettos were isolation hospitals on islands (Figure 1.12). The Old was 525 feet by 425 feet, the New 560 feet by 460 feet. Each was capable of holding 6,730 bales of merchandise. The Old could properly house about 300 passengers, the New 200 (Palmer, 1978, [link]–210; 29). The lazarettos were not only externally isolated but constructed to provide internal isolation of goods and passengers to the individual level. Conditions were frequently appalling. It was not uncommon for people to die at the rate of 500 per day in Lazzaretto Vecchio during plague outbreaks in the sixteenth century, while Lazzaretto Nuovo was recorded as holding 8,000 inmates on one occasion, far beyond the capacities of either lazaretto to do anything worthwhile (Palmer, 1978, p. 195 for example).

The captain of the vessel was taken ashore by a guarded way to a point of examination. The examination turned upon whence the vessel had come, duration of the journey, places visited and their health, visits ashore, contact with other vessels at sea, the health of the ship’s crew and passengers, and the nature of the cargo. Account had to be rendered of any crew or passengers who had died on board or who had left the ship en route “and particularly the Condition of that Person who is wanting” (Magistrato della sanità, 1752, [link]). If the examining officer was satisfied “if the Vessel really come from a place that is free, it [the vessel] is declared free; if from a suspected one [place], the ship was placed in quarantine.”

The principles of quarantine for goods were frequent handling, airing and smoke fumigation with aromatic herbs. Cloth and untreated animal hides were regarded as especially risky. Although the procedure varied in detail by product, bales were generally opened, aired, rummaged and cleaned up to twice a day, and moved from one location to another once a week. For people, social interaction was prevented, and each individual had his/her own cell, garden plot and cooking facilities. Individuals who died in quarantine were checked for plague marks before being buried in lime in holes at least 12 feet deep. In the event that any disease broke out during a quarantine period, the process was repeated so that second and third quarantines were not unheard of for individual ships.

These examples are important for illustrating certain repeating features of quarantine systems down the ages, namely: separation of suspected goods/animals and travellers from the populous for a period long enough to reduce the risk of transmission of infection to the public at large; the idea of a ring system of health check posts around an area; isolation hospitals in which suspected individuals and chattels were housed until cleared; and identification of parts of the world where infection was likely to be found.

Other Lazarettos

Lazarettos came in all shapes and sizes, and Figure 1.13 illustrates two others – the large and complex merchandise lazaretto at Fortezza Santa Maria near Portovenere, Genoa, and, for the people of Rome, the modest hospital on Isola Tiberina in the middle of the River Tiber. Santa Maria served the entire Ligurian coast and was constructed in 1723 especially to receive suspected and contaminated imported goods for cleaning or burning (cf. Venice’s New Lazaretto); see items 8, 9, 11, 12, 13 and 18 for example, in the key. Howard (1791) gives a full account of the principal lazarettos of Europe, along with views and plans. Island locations like those of Venice and Rome were, for obvious reasons, preferred locations, but pseudo-islands like Santa Maria were chosen where islands were not available. Conditions in all were appalling.

Figure 1.13 Lazarettos of Italy. (Upper) Portovenere. (Lower) Rome. The quarantine island for Rome in the middle of the Tiber at Ponte Fabricio is seen in this seventeenth-century view.

Figure 1.13
Lazarettos of Italy. (Upper) Portovenere. (Lower) Rome. The quarantine island for Rome in the middle of the Tiber at Ponte Fabricio is seen in this seventeenth-century view.

Sources: (Upper) Appendix 1.1 (13, 1773, map 40). (Lower) Etching by Jacob Baptist, seventeenth century.

Foreward Planning and Control

In 1700, the eminent Bolognese naturalist and geographer, Luigi Ferdinando Marsili (1658–1730) produced the remarkable map shown in Figure 1.14 (figure located in the colour plate section), 15 months after the Treaty of Karlowitz (1699) which concluded the Austro-Ottoman War of 1683–97. The map was either prepared for or by Marsili who was serving the Habsburg Emperor Leopold I in a Danubian campaign against the Ottoman Empire at the time. Marginal map notes describe Marsili’s map as a “copy”, and hint that it may have been copied from a [Habsburg?] original. It appears to have been one of two maps in a series, the second of which is missing (Jarcho, 1983, [link] and Appendix 1.1 (23)). Turkey was one of the principal conduits of plague into Europe, and the Habsburgs were constructing a cordon sanitaire against plague in this area from the latter years of the seventeenth century (Rothenberg, 1973) which, by 1770 extended along more than 1,000 miles of frontier between Austria and the Ottoman Empire (Rothenberg, 1973, [link]).

Figure 1.14. Planning for plague containment in the Cis-Danubial regions, 1700. Marsili's map envisages clearing of the area of population and houses, along with the maintenance of trade along strictly defined routes. Lazar houses are marked at road intersections, along with cordon sanitaire lines (black lines and dots).

Figure 1.14.
Planning for plague containment in the Cis-Danubial regions, 1700. Marsili's map envisages clearing of the area of population and houses, along with the maintenance of trade along strictly defined routes. Lazar houses are marked at road intersections, along with cordon sanitaire lines (black lines and dots).

Source: Appendix 1.1 (23).

The map is entitled Mappa geographica qua preacautio contra pestem post factam locorum, iuxta Pacis Instrumenta, Evacuationem ac Demolitionem in Confinibus istis Cis-Danubialibus instituenda ostenditur (A Geographical map in which are shown the precautions that are to be taken against the plague within these Cis-Danubial regions after the evacuation and demolition of places in accordance with the peace treaties). The map is at a scale of roughly 1:200,000 and was drawn with south at the top. It shows the eastern coast of the Adriatic from Sebenico (now Šibenik) to Fiume (now Rijeka), a distance of approximately 220 km, and the territories of Croatia, Bosnia, “Sclavonia” and Sirmium as far inland as Belgrade.

The map shows provincial boundaries, two plague cordons (solid black lines and dots) determined by mountain tops, and several lazarettos. A linear scale of hours (travel times) appears in the lower left and a detailed explanation in the upper left. To control the spread of plague if it visited the region, the map proposes that the residents of the region lying south of the yellow line have to be assumed to be susceptible to the disease, and should be detained in the lazar houses which appear at road intersections, to serve their quarantine. Merchants could continue to follow the roads shown by the double pecked lines but all other roads were to be closed to prevent spread of infection. The defence against the plague was not limited to isolation by cordon and lazaretto since the descriptive note states that the system was to be instituted after depopulation of the area by evacuation and demolition of houses. The combined preservation of commercial routes, cordons, lazarettos and checkpoints amounts to “an almost complete depiction of the way in which plague was resisted” (Jarcho, 1983, [link]).

1.3 Prato, 1630

How did the various elements of the Italian system mesh together in a single location? One of the best illustrations is provided by the response of the city of Prato, 21 km northwest of Florence in Tuscany, in the face of the great plague of 1630 (Figures 1.2 and 1.3C). This was the second largest outbreak to hit Italy during the plague centuries. It devastated the northern states over a period of a year from the autumn of 1630. A qualitative account of its course is given in Cipolla (1973, [link][link]). Here we map the sequence of events in Tuscany and Prato to illustrate the highly integrated nature of the control system as surveillance, bans and quarantine were ratcheted up over some four months to try to counter the ever-increasing disease threat.

Figure 1.15 shows Prato was a typical walled Italian town. Originally walled for defence, five main gates penetrated the walls which, in times of plague, could be readily controlled or closed. Communications between Prato and other towns followed the main valleys – along the valley of the River Arno west to Pisa and east to Florence, or northwards towards Bologna (Figure 1.16). Prato fell under the Magistracy of Florence.

Figure 1.15 Prato in Tuscany, c. 1700. Piere Giovanni Fabbroni/Jon. Georg Ringle, 80 × 27 cm. Prospect of Prato from the east showing the walled city with few entry points through the walls. The Convent of St Anne ultimately became the plague hospital. Located well outside the city walls, it appears in the lower left foreground (white box). At this period around 7,000 lived within the walls and 11,000 outside.

Figure 1.15
Prato in Tuscany, c. 1700. Piere Giovanni Fabbroni/Jon. Georg Ringle, 80 × 27 cm. Prospect of Prato from the east showing the walled city with few entry points through the walls. The Convent of St Anne ultimately became the plague hospital. Located well outside the city walls, it appears in the lower left foreground (white box). At this period around 7,000 lived within the walls and 11,000 outside.

Figure 1.16 Controlling the plague in Prato, 1630–31. Sequence of steps taken in Prato in an attempt to defend itself from the great plague epidemic of 1630. (A) 1629. (B) 1630. (C) Prato, 1630. (D) Epidemic curve, Prato, October 1630–July 1631.

Figure 1.16
Controlling the plague in Prato, 1630–31. Sequence of steps taken in Prato in an attempt to defend itself from the great plague epidemic of 1630. (A) 1629. (B) 1630. (C) Prato, 1630. (D) Epidemic curve, Prato, October 1630–July 1631.

Source: based on written account in Cipolla (1973, [link][link]).

The opening moves of the epidemic began in the autumn of 1629 when plague was carried by French armies from the northwest and German armies from the north via Lake Como who entered Italy as part of the Thirty Years’ War, 1618–48 (Figure 1.16A). By the end of 1629, the Milan Health Board had quarantined Savoy, other areas of Piedmont, and Turin. Guards had been placed at all the gates of Milan, the laws governing the use of health passports for goods and people throughout the state of Milan had been reinforced, and communities with fifty or more families were required to enclose inhabited areas and barricade gates. All was in vain and, by the end of 1629, the states of Milan, Savoy, and Piedmont had been banned by surrounding states as far south as Rome to try to prevent spread south into Tuscany and beyond, and east into the Venetian Republic. At the end of October, the health officers in the Magistracy of Florence instructed their opposite numbers in Prato to implement two defence lines – one at the borders of the Grand Duchy to check travel north/south through the mountain passes and fords (Figure 1.16B), and the second around the city itself by placing guards at all the gates.

Spread of the plague was checked over winter, but flowered in full vigour in the spring of 1630 (Figure 1.16B). Plague reached Bologna in mid May, so that Florence required health passes (cf. Figure 1.4) for all travellers into the Grand Duchy. Prato appointed an issuing officer for the purpose. On 12 June Florence reinforced the northern border of the Duchy with more troops and a guard post every three miles (cf. Figure 1.8), banned Bologna on 13th, and raised a general alert to health officers in all walled towns and villages to exercise extreme care when issuing health passes.

On July 1, the grand Duke seconded part of his personal guard further to reinforce border controls in Tuscany. On July 6, movements of friars were stopped. In Prato on July 10th the three most frequently used gates (Mercatale, Fiorentina and Pistoiese) were reinforced with barricades, and the number of health officers increased from four to eight (Figure 1.16C). Despite all this, plague arrived in the city in late September. By 14 November all the city’s gates had been permanently closed except the Mercatale and Pistoiese which had special guards put in place. By the year end, all communications with Prato had been severed; the city was isolated. A plague house for victims was in operation by 31 December. Given the land-locked location of Prato and after much wrangling among vested interests, it was eventually settled to be the Convent of St Anne, outside the city walls. It was to be many more months before the epidemic finally subsided in Prato and the city began to return to normal.

1.4 Models of Control

At the heart of all modern control systems for communicable diseases lies an understanding of how each disease is transmitted from person to person. While this is a medical problem in the first instance, this knowledge is commonly taken forward mathematically both to devise control models and to assess their effectiveness and cost. Such models have attracted mathematical interest from Bernoulli onwards: the classic accounts are given by Bailey (1975) in his Mathematical Theory of Infectious Diseases and by Anderson and May (1991) in their Infectious Diseases of Humans: Dynamics and Control. To give a flavour of their approach to which we return in detail in Chapter 6, a very simplified diagram of the spread of an infectious disease through a human population, which does not involve an intermediate vector like mosquitos in malaria and dengue, is illustrated in Figure 1.17. The population is divided into three sub-populations – those at risk (susceptibles, S), those with the disease (infectives, I), and those who have recovered (recovereds, R). Propagation of an epidemic occurs by homogeneous mixing (mass action) between the S and I populations at a rate β. This generates new cases by the transition SI. Infectives recover or die at a rate μ, while the susceptible population is renewed for future epidemics by births at the rate γ. Population stocks are updated by simple accounting equations. That for I is shown in Figure 1.17 – i.e. the number of new infectives at t + 1 is given by the number at t, plus new infectives generated by the transition SI, minus those infectives at t who recover or die by t + 1. If an epidemic is to be sustained, a continuous chain of infectives must be maintained. Such a chain will continue as long as transmission of infection from infectives to susceptibles can occur.

Figure 1.17 Simplified model of an infection process. The mass action model is based upon person to person contact between infectives, I, and susceptibles, S, at a rate b which generates new cases of the disease. Infected individuals recover or die at a rate m and enter the recovered (removed) population, R.

Figure 1.17
Simplified model of an infection process. The mass action model is based upon person to person contact between infectives, I, and susceptibles, S, at a rate b which generates new cases of the disease. Infected individuals recover or die at a rate m and enter the recovered (removed) population, R.

Source: Cliff, et al. (1993, Figure 16.1 upper, p. 414).

Spatial Mass Action Models

Using the communicable disease of measles, a number of early writers, notably Bartlett (1957) and Black (1966), developed the SIR model into a geographical setting by studying the mixing process between susceptibles and infectives in populations distributed in systems of towns of different sizes. Under these conditions, the parameter β cannot be assumed to be constant in different geographical locations, even for the same disease. Neither can the homogeneous mixing assumption within geographical areas be regarded as reasonable. The upshot of their work was to establish a direct relationship between the population size of a town and the frequency of epidemic waves. They divided waves into three types found in towns of successively smaller population size: Type I waves (large towns), where chains of infection remained continuous and major epidemics flared up at regular intervals; Type II waves (medium-sized towns), in which regular epidemics occurred but where the disease disappeared completely between epidemics; and Type III waves (small towns) in which epidemics occurred irregularly and infrequently, separated by long inter-epidemic periods of unpredictable duration when no cases of the disease were reported. The population threshold crossed when towns cease to display Type II waves and experience Type I waves is called the critical community size; it defines the transition from epidemic to endemic behaviour (Figure 1.18A and B).

A large literature has developed around the SIR model in which refinements have been added to the model to allow (for example) for: inhomogeneous mixing among the population subgroups, especially spatially; vaccination; the latent period of the disease; carrier states; and population recycling from RS (see, for example, Keeling and Grenfell, 1997). The model has often given profound insights into the spread of epidemics, but it is complex to fit to space–time data without heroic assumptions about the stationarity of model parameters and isotropisms of the underlying processes. The longer the time series and the greater the geographical area being studied, the less likely are such assumptions to be tenable, not least because the sensitivity and specificity of disease reporting is unlikely to have remained constant over time.

Barriers to Spread

Thus the spatial dimension to checking communicable disease spread becomes superficially simple to state. It consists of breaking chains of infection by preventing a disease moving from endemic reservoirs to seed infection in smaller communities where the population size is insufficient to sustain the disease on a permanent basis. As shown in Figure 1.19, spatial protection against the spread of infection can be undertaken at two points. The first method, (i), is to interrupt the mixing of infectives and susceptibles with protective spatial barriers. This may take the form of isolating an individual or a community, or of restricting the geographical movements of infected individuals by quarantine. Potential spatial strategies which achieve these goals are illustrated schematically in Figure 1.20. In the two maps, infected areas have been shaded, while disease-free areas have been left blank. In Figure 1.20A, the disease-free areas need to be protected by isolation. Such defensive isolation entails the building of a spatial barrier (a cordon sanitaire) around the perimeter of the disease-free areas, the aim being to prevent infectious cases in any diseased area beyond the pale from gaining access to susceptibles inside the pale. Offensive containment (Figure 1.20B) is the flip side of this, where a containment barrier is interposed between known diseased and disease-free areas to prevent spread from the former to the latter. The diseased area is then cleared of infection by some means or another.

Figure 1.19 Interrupting chains of infection. Alternative intervention strategies based on (i) a spatial strategy, blocking links by isolation and quarantine between susceptibles and infectives and (ii) a generally aspatial strategy, opening of new direct pathways from susceptible to recovered status through immunisation. This outflanks the infectives (I) box.

Figure 1.19
Interrupting chains of infection. Alternative intervention strategies based on (i) a spatial strategy, blocking links by isolation and quarantine between susceptibles and infectives and (ii) a generally aspatial strategy, opening of new direct pathways from susceptible to recovered status through immunisation. This outflanks the infectives (I) box.

Source: Cliff, et al. (1993, Figure 16.1, p. 414).

Figure 1.20 Spatial control strategies. Schematic diagram of two spatial control strategies to prevent epidemic spread. (A) Defensive isolation. (B) Offensive containment. Infected areas are shaded; disease-free areas are left blank. Geographical areas are shown arbitrarily as hexagons.

Figure 1.20
Spatial control strategies. Schematic diagram of two spatial control strategies to prevent epidemic spread. (A) Defensive isolation. (B) Offensive containment. Infected areas are shaded; disease-free areas are left blank. Geographical areas are shown arbitrarily as hexagons.

Source: Cliff, et al. (1993, Figure 16.9, p. 423).

Figure 1.18 Measles propagation in a system of settlements. (Upper) Bartlett’s (1957) findings on settlement size and epidemic recurrence. (A) The impact of population size on the spacing of measles epidemics for 19 English towns. (B) Characteristic epidemic profiles for the three types indicated in (A). In the Type I settlements, which have populations ≥ 250,000, measles is continuously present and there are regularly spaced large epidemics. In Type II settlements (< 250,000) which are still large, there are regular epidemics but there are also gaps between the epidemics when no cases are reported. In the very small Type III settlements (< 10,000 population), there are gaps between epidemics and settlements may miss an entire epidemic. (Lower) (C) Spatial version of the Bartlett model. Conceptual view of the spread of a communicable disease (measles) in communities of different population sizes. Stages in spread correspond to the Bartlett model. Settlements like A, in which measles is permanently present, provide the reservoir of infection which sparks a major epidemic when the population at risk (susceptibles, S) builds up to a critical level (see Figure 1.17). When an epidemic happens, the S population is diminished and the stock of infectives, I, increases as individuals are transferred by infection from the S to the I population. This generates the characteristic ‘D’-shaped relationship over time between the sizes of the S and I populations shown on the end plane of the block diagram. If the total population of a community falls below the quarter of a million size threshold, as in settlements B and C, measles epidemics can only arise when the virus is introduced into it by the influx of infected individuals (so-called index cases) from reservoir areas. These movements are shown by the broad arrows. In such smaller communities, the S population is insufficient to maintain a continuous record of infection. The disease dies out and the S population grows in the absence of infection. Eventually the S population becomes big enough to sustain an epidemic when an index case arrives. Given that the total population of the community is insufficient to renew by births the S population as rapidly as it is diminished by infection, the epidemic will eventually die out. It is the repetition of this basic process which generates the successive epidemic waves experienced in most communities.

Figure 1.18
Measles propagation in a system of settlements. (Upper) Bartlett’s (1957) findings on settlement size and epidemic recurrence. (A) The impact of population size on the spacing of measles epidemics for 19 English towns. (B) Characteristic epidemic profiles for the three types indicated in (A). In the Type I settlements, which have populations ≥ 250,000, measles is continuously present and there are regularly spaced large epidemics. In Type II settlements (< 250,000) which are still large, there are regular epidemics but there are also gaps between the epidemics when no cases are reported. In the very small Type III settlements (< 10,000 population), there are gaps between epidemics and settlements may miss an entire epidemic. (Lower) (C) Spatial version of the Bartlett model. Conceptual view of the spread of a communicable disease (measles) in communities of different population sizes. Stages in spread correspond to the Bartlett model. Settlements like A, in which measles is permanently present, provide the reservoir of infection which sparks a major epidemic when the population at risk (susceptibles, S) builds up to a critical level (see Figure 1.17). When an epidemic happens, the S population is diminished and the stock of infectives, I, increases as individuals are transferred by infection from the S to the I population. This generates the characteristic ‘D’-shaped relationship over time between the sizes of the S and I populations shown on the end plane of the block diagram. If the total population of a community falls below the quarter of a million size threshold, as in settlements B and C, measles epidemics can only arise when the virus is introduced into it by the influx of infected individuals (so-called index cases) from reservoir areas. These movements are shown by the broad arrows. In such smaller communities, the S population is insufficient to maintain a continuous record of infection. The disease dies out and the S population grows in the absence of infection. Eventually the S population becomes big enough to sustain an epidemic when an index case arrives. Given that the total population of the community is insufficient to renew by births the S population as rapidly as it is diminished by infection, the epidemic will eventually die out. It is the repetition of this basic process which generates the successive epidemic waves experienced in most communities.

Source: Cliff, et al. (1981, Figure 3.2, [link]) and Cliff and Haggett (1988, Figure 5.5A, p. 246).

The second method of interrupting the chains of infection, (ii) in Figure 1.19, is to short-circuit the route from susceptible to removed states by creating population immunity through immunisation. Although immunisation in the present era of mass vaccination usually results in generalised population immunity in developed economies, this is not true for many diseases in developing economies or where, for one reason or another, so-called herd immunity has failed or not been achieved (e.g. war zones, refugee camps). Then immunisation takes on a geographical component of where to vaccinate to achieve the best disease control results. These issues form the subject matter of Chapter 4.

A final method of population protection is to relocate susceptible populations into supposedly safe areas (cf. Marsili’s approach in Figure 1.14). Although this may be possible in some instances for animal populations, it is not generally a realistic strategy today for human populations.

Sicily, 1743: The Plague of Messina

Defensive isolation and offensive containment were used in the heel of Italy (Puglia) and in Sicily in 1743 successfully to thwart generalised spread of what turned out to be the last major outbreak of plague in Europe – the Plague of Messina. The regulations under which plague control operated in the Kingdom of the Two Sicilies is best summarised in the Regolamento generale di servizio sanitario marittimo, sanzionato da S.M. il 1 gennajo 1820, in esecuzione dell’articolo 20 legge de’ 20 ottobre 1819 (5). Inter alia, paragraphs 219–235 of the general service regulations specify the geographical structure of a defensive isolation cordon sanitaire to be applied around coastlines, its manning, operation and reporting system. Table 1.1 lists the critical elements, while Figure 1.21 converts these into a schematic diagram; (A) shows the implied arrangement of guard posts along the coast and (B) illustrates the hierarchical reporting system. Many of the features of (A) and (B) – for example, the siting of posts within viewing distance of each other, the complement of three soldiers per post, and the reporting structure – have been noted earlier as the practice for the coastlines of the Republic of Genoa and the Santa Sede.

Table 1.1 Kingdom of the Two Sicilies: geographical structure of the cordon sanitaire specified in the general service regulations of 1820

Paragraph

Regulation

Cordon structure

Geographical features

221

La distanza tra un posto e l’altro dev’ esser tale, che l’uno sia sempre a vista dell’ altro

Each guard post to be within sighting distance of its neighbours

222

Quando in una provincia o valle vi sieno delle coste inaccessibili, per le quali vi ha bisogno di poca o niuna custodia, l’Intendente deve impiegare questo risparmio di forze de cordone per assicurare le spiagge aperte, ed i siti più esposti a degli sbarchi furtive

Any economies in manpower from not having to patrol inaccessible coastal sections to be used to guard open beaches and places most available for clandestine landings

Manning

223

In ogni posto devono montar di guardia tre individui ed un basse uffiziale, che farà le funzioni di capo posto. Quando le spiagge sieno aperte ed esposte in modo che non bastion a custodirle in quattro individui destinati per ciascun posto, può allora aumentarsene il numero a seconda del bisogno e delle circostanze

Normally three guards per post with a low-level official as head of post; four on open beaches difficult to guard, augmented if necessary to suit the conditions

224

La guardia dee recarsi al suo posto la mattina, ed esserne rilevata il domane alla stess’ora, durante il qual tempo è vietato agl’individui che la compongono, il potersi appartare dal posto sotto qualunque pretesto. Il capo-posto dee rimaner fisso per un’inera settimana, ad oggetto di conoscer bene le consegne e trasmetterle, e di conoscere i segnali e le pratiche da osservarsi. Egli ha l’obbligo particolare d’invigilar sulla condotta de’suoi subalterni

Guards must be on station from daylight and relieved the following morning. The head guard has a one-week tour of duty; he has recording, reporting and supervisory duties

225

Per ogni sei posti vi sarà un’Uffizial comandante, che dee rimaner distaccato per un’’intera settimana, e tener presso di se una o più persone a cavallo per la sollecita diramazione degli ordini. La posizione da assegnarsi al suddetto Comandante sarà, per quanto è possible, la centrale. Egli avrà specialmente l’incarico d’invigilare all’adempimento degli oblighi ingiunti a(i)l capi-posti

A sanitary official every six posts, centrally located, on a weekly tour of duty. The official is responsible for distributing orders rapidly using horsemen

226

Per ogni tre distaccamenti di sei posti l’uno, vi sarà un sottoispettore, che anche deve avere una situazione centrale. Il suo incarico è quello d’invigilare alla regolarità del servisio de’tre distaccameni che compongono la sua sotto-ispezione

Three detachments per six posts under the supervision of an under-inspector in a central position

Reporting system

228

Tra tutt’ i capi del cordone vi deve essere una corrispondenza giornaliera ed esatta, onde si rilevi il modo con cui si attende al servizio, e le novità che possono avervi luogo. Affinchè la corrispondenza suddetta proceda colla massima regolarità, e nel modo più celere, i capi-posti devono corrispondere coi rispettivi Comandanti di distaccamento, questi col sotto-ispettore, il sotto-ispettore col’ Ispettore, l’Ispettore contemporaneamente coll’ Intendente, e col Comandante militare della provincia o valle. Da siffatta regola sono eccettuati i casi di seria considerazione ne’ quali, oltre del rapporto regolare da passarsi col cennato metodo, i Comandanti di distaccamento sono autorizzati di far rapporto straordinario, e spedirlo con espresso all’ Intendente ed al Comandante della provincia o valle

Cordon commanding officers must communicate daily with each other. The normal upwards reporting system is from local guard post heads via intermediate officers to the provincial military commander and the sanitary superintendent (Figure 1.21B); the intermediate officers can be by-passed in an emergency

Integrity of the cordon

229

Gli obblighi di tutti gl’individui destinati a formare il cordone, si riducono generalmente ad impedir nelle spiagge l’approdo di qualsivoglia legno, qualunque ne sia la provegnenza, obbligandolo a dirigersi ne’punti più vicini, ove risiede una deputazione de salute

yyAll individuals in the cordon must act to prevent, through a general reduction of manpower, unauthorised beach landings by boat by funnelling those concerned towards the nearest points manned by sanitary officers

230

Ne’ casi di burrasca, i legni amici o nemici possono, quando il naufragio è quasi sicuro, farsi approdare nelle spiagge, impiegando all’ uopo tutte le cautele di custodia, ed un rigoroso cordone parziale, sino a che non accorrano i deputati di salute corrispondenti per applicarvi l’analogo trattamento sanitaria

Shipwrecks to be quarantined by a local cordon sanitaire until sanitary officers can attend

231

Se qualche posto fosse minacciato da gente, che volesse sbarcare a viva forza, ed alla quale non potesse resistere, il capo posto deve innalzare un bandiera di convenzione, ed a questo segnale deve accorrere subito la forza de’ posti limitrofi. Avvenendo questo caso in tempo di notte, il segnale per aver soccorso sarà di due fuochi consecutive

Post heads must signal for support from neighbouring posts if a forced landing is threatened. Two consecutive fire signals used at night

232

In ogni posto devono farsi, durante la notte, de’fuochi convenuti di corrispondenza, a fin di assicurarsi della vigilanza de’posti limitrofi.

Fire signals to be agreed between adjacent posts for night communication

233

Nei tempi di cordone l’esercizio della pesca non è più libero. Le barche pescarecce possono uscire dal levare al tra montar del sole; ed in questo periodo è anche proibito loro di allontanarsi dal lido oltre le quattro miglia. I padroni di queste barche devono essere allora muniti di una bolletta, che i deputati di salute corrispondenti devono loro vistare giorno per giorno

A charge is made for fishing during times of cordon, collected daily by the sanitary inspectors from the boat captain. Fishing is permitted only during daylight hours and not more than four miles from the beach.

235

I cordone sanitari marittimi possono anche stabilirsi per mezzo di altrettante crociere di barche armate, applicandosi a queste, sotto certe tali necessarie modificazioni, le norme di sopra indicate per la distribuzione, il servigio e la dipendenza de’ posti situati a terra su i littorali

Armed boats (felucca) patrol the coastline

Source: based on Petitti (1852, pp. 318–55).

Figure 1.21 Kingdom of the Two Sicilies: Maritime cordon sanitaire. (A) Arrangement of guard posts along the coastline recommended in the general service regulations of 1819–20 (Table 1.1). (B) Reporting system for the cordon.

Figure 1.21
Kingdom of the Two Sicilies: Maritime cordon sanitaire. (A) Arrangement of guard posts along the coastline recommended in the general service regulations of 1819–20 (Table 1.1). (B) Reporting system for the cordon.

Figure 1.22 (located in the colour plate section) illustrates a practical articulation of these arrangements in the cordon sanitaire for the province of Lecce, across the Ionian Sea from Sicily and Messina. Consistent with the legislative framework summarised in Table 1.1 and Figure 1.21, the figure shows the division of the coastline into sections (pecked lines), with the regular and dense network of masonry towers (torre, housing the local sanitary official and section commander; large red circles on Figure 1.22) and guard huts (barracca, each housing three guards or uomini di guardia; black lozenges on Figure 1.22). Armed patrol boats (feluccas) appear offshore (Article 235 in Table 1.1). The entablature gives the manning details for this cordon: 494 guard huts, 79 towers, 2,319 uomini and 160 cavallari (horsemen) along c. 400 km of coast.

Figure 1.22. Province of Lecce, 1743, cordon sanitaire. Distribution of towers and guard huts comprising the cordon sanitaire. The entablature gives manning details.

Figure 1.22.
Province of Lecce, 1743, cordon sanitaire. Distribution of towers and guard huts comprising the cordon sanitaire. The entablature gives manning details.

Source: Appendix 1.1 (18).

Messina had been free from plague since 1624, and the Sicilians prided themselves on the rigour of their quarantine laws which they thought had preserved them. A protective cordon sanitaire of observation posts existed around Sicily as part of this enforcement (Figure 1.23, located in the colour plate section). In May 1743 a Genoese vessel arrived in Messina (Figure 1.24, located in the colour plate section) from Morea (near Patras in the Little Dardanelles), on board of which had occurred some suspicious deaths (plague was present in the Levant at this time). The ship and cargo were burnt but, soon after, cases of a suspicious form of disease were observed in the hospital and in the poorest parts of the town. The Supremo Magistrato di Commercio preferred commercial expediency to rigorous enforcement of the sanitary laws and a major epidemic of plague developed which killed an estimated 40,000–50,000 persons. It was this plague which led to the establishment of the island-wide permanent sanitary magistracy with jurisdiction over the pre-existing local health deputations which had existed for decades to control the importation of infectious diseases.

Figure 1.23. Sicily, 1837: defensive isolation. Extracts from a map of southeast Sicily showing (key) indicazione de' posti del Cordone sanitario terrestre. The map shows the sanitary observation posts (numbered red and blue dots) for the area around Siracusa (Syracuse). These formed part of a centuries-old circum-island ring of posts designed originally to protect the island from incursions of pirates and the plague. The inset list is part of the full list which gives the mode of construction of each post.

Figure 1.23.
Sicily, 1837: defensive isolation. Extracts from a map of southeast Sicily showing (key) indicazione de' posti del Cordone sanitario terrestre. The map shows the sanitary observation posts (numbered red and blue dots) for the area around Siracusa (Syracuse). These formed part of a centuries-old circum-island ring of posts designed originally to protect the island from incursions of pirates and the plague. The inset list is part of the full list which gives the mode of construction of each post.

Source: Appendix 1.1 (21).

Figure 1.24. Plague of Messina, 1743: plague containment. The harbour and fortress of Messina, Sicily, c. 1704, and the location of three internal north–south cordon sanitaire lines used to isolate Messina from the rest of Sicily during the Plague of Messina.

Figure 1.24.
Plague of Messina, 1743: plague containment. The harbour and fortress of Messina, Sicily, c. 1704, and the location of three internal north–south cordon sanitaire lines used to isolate Messina from the rest of Sicily during the Plague of Messina.

Source: (Messina) etching by Gabriel Bodenher, Messina mitt der Neuen Cittadell, 1704. (Map) Appendix 1.1 (20).

Defensive Isolation: Sicily

To prevent spread within Sicily, three internal cordon lines were established in August 1743 by the health officials in Palermo, stretching across the neck of land from Milazzo on the north coast to Taormina on the south (Figure 1.24, located in the colour plate section). From east to west, the cordon lines were: (east) 26 miles (42 km) long, number of posts and men unrecorded; 23 miles (37 km), 152 posts, 700 men; 21 miles (34 km), 130 posts, 633 men (west). This defensive isolation appears to have worked for there is no surviving evidence that plague spread to other parts of the island.

Offensive Containment: Lecce

As noted in Figure 1.20B, an alternative approach to defensive isolation is offensive containment to prevent disease propagation into disease-free areas. During the Plague of Messina, a Turkish ship was unfortunate enough to be shipwrecked off the port of Lecce. Following Article 230 of the General Regulations in Table 1.1, a local cordon was established around the wreck, the boat and contents burned, and the sailors quarantined (Figure 1.25).

Figure 1.25 City of Lecce, tower of Chianca, 1743: local cordon sanitaire. At the time of the Plague of Messina, a Turkish boat was unfortunate enough to be shipwrecked near the tower of Chianca, Lecce harbour. The upper map illustrates the local containment cordon sanitaire erected around the wreck to prevent any risk of plague being carried by the sailors into Lecce. It shows the hut for the Turks (A), Chianca tower (B), the five sanitary guard huts (E), the stockades used to separate the Turkish compound from the guards (H, I), an armed patrol boat (felucca, G) and the felucca with the public health officers on board (M). The lower map of the heel of Italy is an extract from a sixteenth-century Ottoman map of the area. The town of Lecce (1) is a few miles inland from the port (3) with its disembarkation point (2, boxed) where the wreck occurred. Other towns marked are Roca Vecchia (4), Otranto (5) and Tricasi (7). (6) is Capo Santa Maria di Leuca. The towns are all walled.

Figure 1.25
City of Lecce, tower of Chianca, 1743: local cordon sanitaire. At the time of the Plague of Messina, a Turkish boat was unfortunate enough to be shipwrecked near the tower of Chianca, Lecce harbour. The upper map illustrates the local containment cordon sanitaire erected around the wreck to prevent any risk of plague being carried by the sailors into Lecce. It shows the hut for the Turks (A), Chianca tower (B), the five sanitary guard huts (E), the stockades used to separate the Turkish compound from the guards (H, I), an armed patrol boat (felucca, G) and the felucca with the public health officers on board (M). The lower map of the heel of Italy is an extract from a sixteenth-century Ottoman map of the area. The town of Lecce (1) is a few miles inland from the port (3) with its disembarkation point (2, boxed) where the wreck occurred. Other towns marked are Roca Vecchia (4), Otranto (5) and Tricasi (7). (6) is Capo Santa Maria di Leuca. The towns are all walled.

Source: (main map) Appendix 1.1 (19); (inset map) Salierno (2010, [link]).

1.5 Conclusion

This book considers how the geographical spread of communicable diseases from one area to another may be prevented or at least controlled. Using largely unknown maps in Italian state archives, this chapter has shown how, from the establishment of the first quarantine station by the Republic of Ragusa (modern-day Dubrovnik) in 1377, 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.

With the Italian ideas as historical context, we now move in the remainder of the book to bring the disease control problem into a modern framework with chapters on surveillance (Chapter 2), quarantine (Chapter 3), vaccination (Chapter 4), eradication of infectious diseases (Chapter 5), and planning for control in the twenty-first century (Chapter 6).

Appendix 1.1: Map Sources

This Appendix gives the sources of the maps used in this chapter. The item numbers correspond with the key map shown in Figure 1.6. All plates with sources cross-referenced to this Appendix have been reproduced by kind permission of the Directors of the State Archives and Libraries cited.

Venice

Archivio di Stato di Venezia (ASV)

1. Giancomo Binard

Mappa del territorio del basso Friuli compreso tra Palma la linea formata dal- l’Iudri, il Torre e l’Isonzo e Cervignano, con l’indicazione delle postazioni sanitarie. 4 marzo in Udine; scala di miglia 3 = mm 30; dim mm 940 × 650. Disegno a mano, su carta, con colorazioni ad acquarello. ASV. Provveditori alla Sanità, Disegni, B2N8.

2. Iacopo Spinelli

Mappa con parte del corso del fiume Natisone e tracciate le postazioni di guardia al confine tra il Friuli e la Schiavonia veneta in caso di epidemie. 1714; scala di miglia = mm 90; dim mm 1,025×720. Disegno a mano, su carta, con colorazioni ad acquarello. ASV. Provveditori alla Sanità, Disegni, B3N12.

3. Tommaso Pedrinelli

Mappa comprendente parte del territorio Vicentino dei Settecommni e Bassanese al cinfine con il Trentino e con l’indicazione dei posti e guardie sanitarie. 28 febbraio 1739, Bassano; scala di miglia italiane 5 = mm 155; dim mm 1,140×975. Disegno a mano, su carta, con colorazioni ad acquarello. ASV. Provveditori alla Sanità, Disegni, B3N16.

4. P. Guiseppe Di San Francesco

Mappa con la linea di confine tra l’Istria veneta ed il territorio austriaco e gli appostamenti sanitari posti da Zaule, territorio di Muia e Fiauona, territorio d’Albona. 1712; scala di miglia italiane 5 = mm 162; dim mm 1,230×1,305. Disegno a mano, su carta, con colorazioni ad acquarello. ASV. Provveditori alla Sanità, Disegni, B1N16.

5. Pietro Soranzo

Mappa del territorio di Imoschi (Dalmazia veneta) confine con l’Impero Ottomano, con il territorio Sign, di Duare e di Vergoraz ed i caselli ed appostamenti sanitari. 18 novembre 1783; scala passi veneti 2400 = mm 130; dim mm 1,570×765. Disegno a mano, su carta, con colorazioni ad acquarello. ASV. Provveditori alla Sanità, Disegni, B4N21.

6. Giancomo Pellegrini

Mappa con il litorale di Monfalcone da Porto Anfora al castello di Duino e con l’indicazioni dei posti di guardia sanitari al confine con

gli arciducali. 13 novembre 1713, Monfalcone; scala miglia Quattro = mm 140; dim mm 1,430×675. Disegno a mano, su carta di più pezzi uniti insieme e riforzati con tela, con colorazioni ad acquerello. ASV. Provveditori alla Sanità, Disegni, B1N3.

7. (Unknown) Colognese (Territorio)

Mappa del territorio colognese, al confine con le province di Padova e Vicenza, con i castelli e le separazioni stabilite dal Provv. Gen. in T.F. in occasione di una epidemia bovina. 10 guigno 1747; dim mm 420×340. Disegno a mano, su carta, con colorazioni ad acquarello. ASV. Provveditori alla Sanità, Disegni, B4N19.

8. Gio. Giancomo Pelligrini Monfalcone (Territorio)

Mappa del territorio di Monfalcone compreso tra il lago di Pietra Rossa e il corso del fiume Isonzo con l’indicazione delle ville, posti e caselli di guardia sanitari al confine con il granducale. 1713; di miglia due = mm 123; dim mm 1,400×700. Disegno a mano, su carta, di due pezzi uniti insieme rinforzati con tela, con colorazioni ad acquarello. ASV. Provveditori alla Sanità, Disegni, B5N26.

9. Bartolo Riviera Friuli

Disegni con raffigurati gli appostamenti di cavalleria e di fanteria creati ai confini del Friuli in occasione di epidemie. (Att. Linea di confine per contaggio dei Bovini fatta nel Friuli – 87). Sec. 18; dim mm 1,040×395. Disegno a mano, su carta di due pezzi uniti insieme, con colorazioni ad acquarello. ASV. Provveditori alla Sanità, Disegni, B5N27.

10. Gio Batta Cavalcaselle Veronese (Territorio)

Mappa con parte del territorio veronese al confine con il mantovano e il ferrarese e con la descrizione di vari caselli sanitari. Sec 18; scala di miglia di circa = mm 125; mm 958×730. Disegno a mano, su carta rinforzata su tela con colorazioni ad acquarello. ASV. Provveditori alla Sanità, Disegni, B5N29.

11. Unknown Budua (Territorio Di)

Mappa comprendente un tratto di mare tra Porto Rose e Castel di Lastva ed i territori di Cattaro Zupa, Budua, Maini e Pastroviech con l’indicazione dei posti di confine. Sec 18; dim mm 785×580. Disegno a mano, su carta di due pezzi uniti insieme e rinforzata con tela, con colorazioni ad acquarello. ASV. Provveditori alla Sanità, Disegni, B6N34.

12. Vicenzo Bernardi Adige (Fiume)

Parte del corso del fiume Adige all’altezza di Ossevigo in territorio veronese, con l’indicazione degli appostamenti al confine, lungo la strada postale. Sec 18; scala pertiche veronesi 100 = mm 180; dim mm 1,260×720. Disegno a mano, su carta di più pezzi uniti insieme, con colorazioni ad acquarello. ASV. Provveditori alla Sanità, Disegni, B7N43.

Genoa

Biblioteca Civica Berio

13. Matteo Vinzoni

Piante delle due Riviere della Serenissima Repubblica di Genova. Divise Ne. Commissariati di Sanita. Cavate Dal M. Col. Ing. Matteo Vinzoni. Per Ordine Dell’ Ill Mag. di Sanita. 1758; mm 528×355; cc. 119 complessive, num nel sec XVIII per pagg 230 (escluso il foglio di guardia ant. e il front.). Mostra di manoscritti e libri rari della Biblioteca Civica di Berio di Genova.

Il Dominio della Serenissima Republica de Genov in Terrafirma. 1773. Facsimile edition; mm 340×240; Mostra di manoscritti e libri rari della Biblioteca Civica di Berio di Genova. Genova: Compagnia Imprese Elettriche Liguri, 1955.

Santa Sede (Holy See)

Archivio di Stato di Roma (ASR)

14. Gaspare Grassellini

Carta topografica sanitaria del littorale del Mediterraneo nello Stato Pontificio dal confine del Gran Ducato di Toscana quello del Regno di Napoli nel rapporto di 1 a 1000000. Compilata nel Dicastero Generale del Censo essendo Pro Presidente sua eccnza RMA Monsignor Gaspare Grassellini per uso della Congregazione Generale di Sanità. 9 decembre 1843. Scala 1:100,000; dim mm 2,790×415; disegno a penna su carta, colorato. ASR. Disegni, Coll I cart 106f, 215.

15. Guiseppe Vaselli

Topografica del Littorale Pontificio, nell’ Adriatico, e del confine terrestre col Regno di Napoli portante l’armamento del cordone sanitario, ripartito in quattro Divisioni (Stato generale della forza impiegata dell’ Adriatico, e confine col Regno di Napoli). Ancona, marzo 1816; dim mm 550×1,580; disegno a penna su carta, colorato. ASR. Disegni, Coll I cart 106f, 218.

Tuscany

Archivio di Stato di Firenze (ASF)

16. Unknown Livorno (Torri Costiere)

Piano specificazione e stato delle Torri e Posti che sono situati sul Lido del Mare da Livorno fino a Torre Nuova, aumentati in occasione della contumacia della Città di Messina dell’anno MDCC XLIII (1743). 1743. Scala di miglia italiane 10 = mm 215; dim mm 435×1,385; disegno a penna su carta, colorato. ASF. Miscellanea di piante 5/20, 38.

17. P. Giovanni Fabbroni Toscana (Torri Costiere)

Pianta della costa del Mare Toscano guarnita con tutte le sue Torri e Casotti fatta in occasione della Peste di Messina l’anno MDCCXXXXIII principiando dalla Torre del Cinquale fino alla Torre di Cala del Forno che confina con lo Stato di Orbetello. 1754. Scala di miglia 6 = mm 76; dim mm 770×2,110; disegno à penna su carta telata, colorato. ASF. Disegni, Miscellanea di piante 5/20, 258.

Naples

Archivio di Stato di Napoli (ASN)

18. Augustin De Bargas Machuco Lecce

Piano dimostrativo della marina di Lecce e del suo cordone marittimo. 1743. Scala di miglia quindici italiane pari a mm 95; dim mm 355×485 (350×480); disegno a inchiostro acquerellato. Segreteria di Stato d’Azienda, fs. 253, fascic. 20.

19. Soprintendenza Generale Della Salute Lecce, Chianca Di

Pianta delle baracche e rastelli fatti costruire per la custodia dei Turchi naufragati nella marina della torre della Chianca di Lecce. 1743. Scala di palmi 200 pari a mm 110; dim mm 415×285 (385×265); disegno a inchiostro acquerellato. Segreteria di Stato d’Azienda, fs. 252, fascic. 38.

20. Vicari Generali (General Vicars)

MESSINA, 1743. Relazione topografica dell’ intèro cordone, commandato dalli 3: Vicai Generi il quale hà li suoi termini nelli due mari di Milazzo, e Taormina che per linea retta saria miglia so mà per tortuosa come al pres ritrouasi si estende a miglia. Dim mm 910×920; disegno a inchiostro acquerellato. Piante e disegni, busta XXXIII, 8.

Palermo

Archivio di Stato di Palermo (ASP)

21. Alì Innocenzo: Ministero E Real Segreteria Di Stato Presso IL Luotenente Generale in Sicilia, Ripartiment Lavori Pubblica

Pianta topografica del littorale della valle di Siracusa distinto nei littorali rispettivi di ogni comune e con l’indicazione dei posti di cordone sanitario terrestre. Siracusa 30 April 1837. Miglia siciliani; dim mm 920 × 1,310; disegno a penna su carta, colorato.

Bari

Wellcome Trust Medical Photographic Library, London

22. F. De Arrieta

Ragualio historico del contaggio occorso nella provincial di Bari negli anni 1690, 1691, e 1692. (Naples, Parrino and Mucii, 1694.) 324×180 mm. Scale ≈ 1:500,000. The map is on [link].

University of Bologna

Library of the University of Bologna

23. L. F. Marsili

Mappa geographica, qua praecautio contra pestem post factam locorum, juxta pacis instrumentum, evacuationem ac demolitonem in confinibusistis Cis Danubialibus instituenda ostenditur. See Frati, L. (1928). Catalogo dei Manoscritti di Luigi Ferinando Marsili Conservati nella Biblioteca Universitaria di Bologna, p. 213, entry 25 (Firenze: Olschki). A manuscript map prepared by or for Marsili and dated April, 1700. Dimensions: mm 224×130. Scale ≈ 1:500,000.