\ 
 
 DUPLICATE 
 
 HX00015148 
 
 ^^^x.vr w jpjLYEK i:n^stitute, bulleti:n^ xo. 12, 
 
 Treasmy Department, Public Health a)td Marine-Hospital Service. 
 
 WALTER WYMAN, Surgeon-General. 
 
 The Early History of ^oarantine: 
 
 ORIGIN OF SANITARY MEASURES DIRECTED AGAINST 
 
 YELLOW FEVER, 
 
 BY 
 
 Passed Asst. Surg. J. M. EAGER. 
 
 MARCH, 1903. 
 
 WASHINGTON: 
 
 GOVERNMENT PRINTING OFFICEo 
 
 "ollsp of PhriilcU.ns and Surgeons 
 Libr Mi-y 
 
YELLOW FEVER I:N^STITUTE, BULLETD<r I^o. 12. 
 
 Treasury Department, Public Health and Marine- Hospital Service. 
 
 WALTER WYMAN, Surgeon-General. 
 
 The Early History of Quarantine: 
 
 ORIGIN OF SANITARY MEASURES DIRECTED AGAINST 
 
 YELLOW FEVER, 
 
 BY 
 
 Passed Asst. Surg. J. M. EAGER. 
 
 MARCH, 1903. 
 
 WASHINGTON: 
 
 GOVERNMENT PRINTING OFFICE, 
 1903. 
 
YELLOW FEVER INSTITUTE. 
 
 Treasury Department, Public Health and Marine-Hospital Service, 
 WALTER WTMAN, Surgeon-General. 
 
 Bulletin No. 12. 
 
 Section D.— QUARANTINE AND TREATMENT. Asst. Surg. Gen. W. J. PETTUS, Chairman of Section. 
 
 THE EARLY HISTORY OF QUARANTINE-ORIGIN OF SANITARY MEASURES 
 DIRECTED AGAINST YELLOW FEVER. 
 
 By p. A. Surg. J. M. Eager. 
 
 IT'EBR.XJ^^.R.^^, 19 03. 
 
 The public sanitary measures included in the comprehensive term 
 "quarantine" have been more extensively applied in America against 
 yellow fever than against any other disease. Most of these measures 
 had their origin long before yellow fever was known to the world. 
 The way they came into existence and how they were later used as a 
 protection against yellow fever is one of the most interesting topics 
 in sanitary history — one without which no account of the prophjdaxis 
 of 3"ellow fever would be complete. In the present writing the term 
 "quarantine" is not limited to its narrower sense, but is taken to mean 
 any restraint, owing to contagious disease, of intercourse on land or 
 b}^ sea. It includes such incidental measures as disinfection. 
 
 The history of quarantine is closely interwoven with that of medi- 
 cine in general and of shipping. We read of these practices being 
 applied against leprosy in biblical times, and Captain Cook, the Eng- 
 lish navigator, tells us that the savages of the South Sea Islands, who 
 had not advanced beyond the stone age at the time of his visit to those 
 islands, resorted to rude sanitary precautions in the case of arrivals 
 from neighboring places. 
 
 3 
 
The story of the beginnings of quarantine is associated particularly 
 with the epidemiology of leprosy, pest, and sj^philis. Cholera and 
 yellow fever were later considerations. The first reported prevalence 
 of yellow fever was at Bridgetown, Barbados, in 1647, the year before 
 the great pest of Habana. At this time quarantine measures had been 
 practiced against other malignant contagious diseases, a maritime quar- 
 antine station having been in operation at Venice in 1403, nearly a 
 century before the discovery of America. It was onl}?- necessary to 
 include yellow fever in the category of contagious exotic diseases and 
 apply against the malady the procedures already in vogue. The first 
 appearance of yellow fever in Europe occurred at Lisbon in 1723, and 
 is described in the article "Yellow fever in Portugal" (Bulletin No. 
 4, Yellow Fever Institute, United States Public Health and Marine- 
 Hospital Service). It was not, however, until 1821, following an 
 extensive epidemic in Spain, that quarantine was applied in Europe 
 against yellow fever. The Spanish academies were interpellated as to 
 the nature of the disease, and as a result of their replies yellow fever 
 was declared quarantinable. Inquiry in England in 1823 and 1824 was 
 followed by an act of Parliament directing quarantine against yellow 
 fever in the same way as against plague. Quarantine theory and 
 practice have from the beginning followed medical dogma. Religion, 
 astrology, and crude or false doctrines of etiology extended their 
 influence. Like most branches of practical medicine, the practice of 
 quarantine passed from the hands of priests into those of empiricists. 
 It took ages for public sanitation to establish itself on a scientific basis. 
 
 LEPROSY AND LAND QUARANTINES. 
 
 The first quarantines of which any mention is made in literature 
 were land quarantines used as a protection against leprosy. The 
 ancients regarded this disease as of African origin, and Lucretius 
 states positively that it first came from Egypt. In the Old Testament 
 the first indications are found of precautions taken against contagious 
 maladies. Leviticus, Numbers, and the First Book of Samuel give 
 directions for the sequestration of lepers, first in the desert, then out- 
 side the camp, and afterwards without the walls of Jerusalem. In 
 these books the inspection of persons for the detection of leprosy is 
 detailed. Persons afilicted with skin diseases were directed to present 
 themselves before the priests. An observation of each case was made, 
 and, according to minutely described sj-mptoms, isolation of the 
 patients was ordered for a prescribed period. 
 
 The crusaders on their arrival outside the walls of Jerusalem found 
 lazarettoes still in existence, and after taking the city from the Mussul- 
 mans sent all contagious maladies to these isolated places. The name 
 Hospital of St. Lazarus was given to the place of sequestration. 
 Returning to Europe, the members of the military expeditions brought 
 
back with them not only numerous diseases, but also the word "laza- 
 retto,-' as applied to a place for the isolation of the victims of com- 
 municable maladies. As a result lazarettoes were built outside the 
 gates of nearly all the principal cities of Europe. Leprosy itself had, 
 however, been introduced into Europe many centuries earlier. It is 
 spoken of as a foreign disease by the earlier Greek and Latin writers. 
 Plin}^ thinks that leprosy was introduced into Europe by Pompey 
 returning to Rome from Syria after his celebrated triumph over fif- 
 teen nations in Asia. It is implied that leprosy walked with the three 
 hundred princes before the triumphal car of the conqueror. These 
 surmises give rise to the interesting query whether leprosy was not 
 the first quarantinable disease introduced by sea. As a quarantinable 
 disease leprosy takes precedence in several ways. For instance, it 
 was the first quarantinable disease (quarantinable from the point of 
 tiew of the United States quarantine regulations) of which the 
 causative germ was discovered. 
 
 During the epoch of the crusades leprosy became widespread in 
 Europe and resulted in the extensive establishment of isolation sta- 
 tions. Leper houses existed at Metz, Verdun, and Maestricht as 
 early as the seventh century, for long before the crusades the disease 
 had spread from Italy into the Roman colonies of Gaul, Britain, and 
 Spain, and thence into the most remote countries. Mathew Paris 
 estimates that at the time of the great epidemic of leprosy in western 
 Europe succeeding the movement against the Mohammedans 19,000 
 lazarettoes were in operation in Europe. Religious orders conducted 
 the houses bearing the name of St. Lazarus, but in northern Europe 
 many dedicated to St. George were under secular supervision. Not 
 only were persons sufi'ering from leprosy and other contagious dis- 
 eases sent to such asylums, but the insane and individuals whose sep- 
 aration from society was deemed an advantage to the populace or the 
 ruling powers were also confined there. In these places of isolation 
 quarantine measures, that afterwards had their application at maritime 
 stations and ultimately were directed against j^ellow fever, developed 
 primarily. Lepers were not strictly confined to the leper houses. 
 They were, however, required to wear a special costume, to limit their 
 walks to certain roads, to give warning of their approach by sounding 
 a clapper, and to forbear communicating with healthy persons and 
 drinking from or bathing in any running stream. 
 
 PEST AND EARLY VIEWS OF ETIOLOGY. 
 
 In connection with pest and later with syphilis the greatest advances 
 of mediseval times took place in public sanitary methods, leading to 
 the establishment of maritime and land quarantines. During the 
 Middle Ages more attention was given to the isolation of leprosy than 
 of other diseases now known to be virulently contagious, for the reason 
 
6 
 
 that the minds of medical men were hampered by accepted doctrines. 
 One of the first of these dogmas AYas founded on the fact that, while in 
 the sacred Scriptures minute attention is given to precautions against 
 leprosy and skin diseases, no measures are prescribed against pest. 
 Yet most disastrous epidemics are recorded in the Old Testament. 
 
 By the word pest is understood not only bubonic plague, but the 
 different epidemic diseases, whatever they may have been, that were 
 formerly included under that term. In their application to this group 
 of maladies the various docrines of etiology had a most important 
 bearing- on etiology. The historj^ is preserved in a great number of 
 documents, many of them obscure and quaint, but all interesting as 
 showing the gradual development of public sanitation. From an 
 etiological standpoint the history of public hj^giene in its relation to 
 epidemiology is divided into four periods, during all of which widely 
 diverse views of causation of epidemic disease were held, the state of 
 knowledge in each successive epoch advancing nearer the truth. First 
 came a chaotic period up to the time of Hippocrates, secondly the cen- 
 turies that intervened from the time Hippocrates set forth his views 
 of etiology to the middle of the sixteenth century, when Fracastoro, 
 basing his observations on the epidemic prevalence of sj'philis that 
 extended throughout Europe, announced a theory of contagion. 
 Then followed an interval lasting until the evidence of a living con- 
 tagion gained credence. Lastly came the time when specific germs 
 were found to be the cause of epidemic disease. The last era, how- 
 ever, brings the history of quarantine to such a recent time as to be 
 outside the scope of the present writing. 
 
 . The word plague as well as pest was given by ancient medical writers 
 to any epidemic disease that wrought an extensive destruction of life. 
 Oalen, for example, used the word in this sense. Histor}^ is replete 
 with epidemics. Instances of ancient prevalences are the disastrous 
 disease, recorded in II Kings, causing the destruction of the Assyrian 
 army; the plague of Athens, described by Thucydides; the great 
 pestilence in the reign of Marcus Aurelius, that extended over almost 
 the whole of Europe, and the plague of Justinian, descriptions of 
 which are given by Procopius and Evagrius. The plague of Justinian 
 lasted for fifty years and has a decided interest in connection with the 
 present subject, having been introduced in all probability largely by 
 sea. It began at Pelusium, in Egypt, 542 A. D. After spreading 
 through Egypt it appeared the next year at Constantinople. In sub- 
 sequent years it advanced over the entire Roman world, making its 
 initial appearance in seaboard towns and radiating inland. Frequent 
 epidemics occurred in succeeding centuries, one of the most important 
 of which was the great cycle of epidemics in the fourteenth century, 
 which has been given the name of the "black death." Throughout aU 
 
this extensive period notions and practices relating to public sanita- 
 tion were being evolved in accordance with the prevalent tenets of 
 causation. In the earliest period religion, superstition, and stellar 
 influence took the principal place in the confused ideas of etiology. 
 Ill-ordered doctrines led to all sorts of irrational practices. Among 
 the Greeks, in the rites of ^sculapius, the sick were not permitted to 
 enter the temples, where they underwent treatment, without first 
 being purified by various baths, frictions, and fumigations. All this 
 was accompanied by ceremonies similar to those practised within the 
 temples, namel}", magical performances and fervent prayers recited in 
 a loud voice, often with musical accompaniment. As an accessory to 
 the purification preliminary to being admitted, the patient was 
 required to pass the night stretched on the skin of a sheep that had 
 been offered as a sacrifice. Here he was ordered to compose his mind 
 for sleep and await the arrival of the physician. Throughout these 
 ages as well as in more recent times a fanciful association between 
 the phenomena of the material world and the destinies of mankind 
 closely linked the doctrine of etiology with astrology. The persistent 
 belief of learned men in the relation of stellar conditions to epidemics 
 is in part explained by the fact that astrologers who predicted epi- 
 demics wrought charms against the impending pestilence, thus saving 
 their credit, in event the disaster did not materialize, hj claiming that 
 it had been averted through their efforts. These primitive views of 
 the origin of epidemics did not necessarily place the cause of the dis- 
 ease outside the earth and its immediate surroundings. Winds, 
 thunder and lightning, fogs, and other meteors were blamed for caus- 
 ing pestilence, and the flight of birds and insects were supposed to be 
 dependent phenomena. Xanaphanes, five hundred or six hundred 
 years before Christ, expounded an idea that the sun was a torch and 
 the stars candles that were put out from time to time. According to 
 his notion, which was seriously accepted, the stars were not heavenly 
 bodies in the wider sense, but meteors thrown off from the earth. So 
 a belief in stellar influence did not carry the mind outside worldly 
 ranges. For this reason other practices than prayers and sacrifices 
 were believed to be effective. They consisted chieflj- in efforts to dis- 
 sipate the meteors, such as huge and numerous fires, and to avoid 
 meteoric influence by confinement in closed or otherwise protected 
 places. 
 
 During the period under consideration, the promptings of supersti- 
 tion were paramount and the epidemiologists of the times confined 
 themselves principally to interpreting- the signs of the heavens. More 
 advanced views came as the result of reasoning, but the path of dis- 
 covery by experimental science was not entered upon until after many 
 centuries. 
 
ETIOLOGY ACCORDING TO HIPPOCRATES. 
 
 The doctrines of etiology took a more determinate form under the 
 teachings of Hippocrates. According to Hippocrates, disease has its 
 origin either in the regime of life or in the air that surrounds the 
 living body and enters into it. He made therefore a twofold etiolog- 
 ical division of diseases, those dependent on the personal regime, and 
 those dependent on the quality of the air. Regarding the latter class, 
 when many individuals are attacked by the same disease at the same 
 time, he supposed the cause to be a common one, namely, the air 
 breathed. Hippocrates believed that a regime of life, which differs 
 with different persons, could not be the cause of a malady that attacks 
 alike the young, the old, men and women. On the other hand, when 
 diseases of different sorts occur, it was clear to him that the cause is 
 individual. Epidemic disease, according to the Father of Medicine, 
 is often promoted by a specific, unknown, and extraordinary condition 
 of the air due to the presence of the (luid divinum^ which may also 
 exist in miasms and certain other impure things. This qidd dimnwn 
 has given much trouble to the followers and commentators of Hippoc- 
 rates, and the judgment as to what he conceived it to be must be left 
 to the fancy of the student of his writings. It seems probable, how- 
 ever, that Hippocrates meant the scourge of divine wrath. It was 
 this very idea that for centuries prevented the application of sanitary 
 measures to epidemic disease. Men regarded pestilence as a punish- 
 ment inflicted hy the Almighty on delinquent humanity and an attempt 
 to turn aside a weapon borne in the divine hand was considered vain 
 and impious. 
 
 The influence of Hippocrates's views, with their bearing on sanita- 
 tion, extended with slight abatement almost to the time when Fracas- 
 toro announced his doctrine of contagion. Throughout all this period, 
 moreover, the controlling power of Platonism held experimental 
 inquiry in check. It was believed that the true nature of things could 
 be discovered hj the action of reason and not in any important degree 
 by experience and observation. Thus, it will be seen, the measures 
 directed against epidemic disease were often misguided, ineffective, 
 and dependent on all sorts of false doctrines. 
 
 GAIiEN'S VIEWS OF EPIDEMIOLOGY. 
 
 Galen, not dissenting from the views of Hippocrates, was of the 
 opinion that any disease that caused the almost simultaneous death of 
 a large number of people should be regarded as of the nature of pest. 
 He did not hold to any view of contagion in these maladies, that is, of 
 their direct communication of man to man, though he evidentl}" 
 believed that the corruption of the air was more intense in the neigh- 
 borhood of the sick than elsewhere. Pest, he declared, was born of a 
 
9 
 
 pollution of the atmosphere and assailed man by way of respiration. 
 This doctrine was accepted by the pupils of Galen. In the commen- 
 taries of the books of Hippocrates on epidemics, or popular diseases, 
 as they were called, it is asserted that pestilential maladies proceed 
 from a special condition of the heavens. These commentaries, at 
 one time attributed to Galen, have since been demonstrated to be 
 the production of his disciples. The long line of Greek, Latin, and 
 Arabic medical writers down to the time of Avicenna, the Moham- 
 medan physician, adhered to the teaching of Hippocrates and Galen, 
 and when they speak of contagion the term must always be under- 
 stood to mean contracting a disease by breathing altered air. The 
 masters of medicme of the middle ages held similar opinions. Ber- 
 nardo Gorgonio, professor of medicine at Montpellier, France, in 
 1300, and Arnaldo da Villanova, who lived toward the end of the 
 twelfth century, gave the name of pestilent fever to every deadly 
 fever and maintained the cause to be a corruption of the air. Gug- 
 lielmo Varignara, professor of medicine at Bologna in 1302, not only 
 denied the contagious nature of measles and smallpox but declared 
 that the buboes of plague were not contagious. Gentile, who died of 
 pest at Foligno, Italy, in 1348, believed that the poison of pest existed 
 in the air and was due to a putrefaction of this medium. John Godes- 
 den, a leading English physician of the fourteenth century, announced 
 the same views. De Chauliac, an eminent French physician of Avig- 
 non, who observed the terrible epidemic of 1348-1361, recorded 
 casually his idea that pest could be contracted by contact with the sick, 
 but assigned as a primary cause decomposition of the air due to the con- 
 junction of planets whereby a certain subtle substance is evolved capable 
 of producing epidemics. Another famous physician of those times, 
 Raimondo da Vinario, who was a spectator of the epidemics of pest in 
 1348-1361 and 1373, says that it is a very dangerous thing to have to 
 do with persons stricken with pest; that one person sick with pest 
 may infect an entire city; that those emploj^ed in public hygiene in 
 times of epidemic prevalence take the malady by contagion; that phy- 
 sicians more than any other class are likely to catch the disease; and 
 that monks are generally exempt from pest because they are isolated 
 in monasteries and thus free from outside exposure. Still there is not 
 room to believe that this master of medicine had any precise concep- 
 tion of the nature of contagion. Like so many others, he put his 
 faith in corruption of the air brought about by an influx of stars, 
 planets, and constellations, and in poisonous exhalations emanating 
 from the earth. The danger of contact with the sick he conceived to 
 be due to the air filled with pestilential poison that had been inspired 
 and afterwards exhaled by the victims of the disease. Da Vinario 
 held also that garments worn by the sick and other fabrics in close 
 contact with them contained the infective principle, and hence should 
 
10 
 
 be transported with the sick to a distant and isolated place. Notwith- 
 standing- all this, he does not mention the necessit}^ for purification of 
 infected tilings nor ever suggest the caution of destrojdng fomites. 
 There can be no stronger evidence than this of the tenacity with which 
 the physicians of the middle ages adhered to the accepted doctrines of 
 their predecessors. 
 
 THE BEGINNINGS OF RATIONAL, ETIOLOGY. 
 
 It took centuries of involuntary observation to shake the idea that 
 epidemics are of celestial origin and to be combated by prayers, fast- 
 ing, and processions. The first advances toward ?jroader ideas were 
 not made by medical men. The record of reformed views is found in 
 works on jurisprudence and in the narratives of travelers. In the 
 books of jurisjjrudence of the emperors of the East it is noticed that 
 care should be exercised in having relations with persons arriving 
 from places where pest reigns. It was ordered, in consequence, that 
 those so exposed should be separated from others for the purpose of 
 observation. The term of forty days (whence the word quarantine) 
 is named, this being the supposed maximum period of the duration of 
 acute maladies. Whether this isolation was practiced in a particu- 
 larly selected place or in the houses of the suspects is not known. 
 
 Merchants traveling in the East and detained at Alexandria or Cairo 
 during the prevalence of pest observed that cloistered monks did not 
 contract the disease. Many of these merchants, exiled b}'^ pestilence, 
 staid constantly within the boundaries of their residences, transacting 
 all business through barred windows and from terraces that crowned 
 the house tops. The stubbornness with which medical men held to 
 the doctrine of aerial corruption of celestial origin is shown by the 
 report made to the Marseille government in 1720 b}- a body of dis- 
 tinguished physicians, in which the condition of the air was pronounced 
 to be the sole cause of pest, the idea of communicabilitj^ from man to 
 man being absolutely rejected. 
 
 One of the most ancient edicts commanding the segregation of suf- 
 ferers from pestilential maladies had for its authors two la3^men, 
 Sagacio and Pietro de Gazata, and is found in the chronicles of Reggio 
 d'Emilia. The document, dated 1374 and written in low Latin, orders 
 that all persons sick with pest be taken outside the city, into the open 
 country, a camp, or the woods, there to remain until dead or cured. 
 The parish priests are required to promptly report all cases of pest 
 under pain of death by fire. After registering these historical facts, 
 the chronicler adds: 
 
 And I saw in this same year that these orders were observed in Eeggio, for which 
 cause all were grieved and terrified more than by the fear of the illness which, when 
 God permits, can not be averted. 
 
11 
 
 ORIGIN OF THE DOCTRINE OF CONTAGION. 
 
 The credit of having created the doctrine that pest is contagious by 
 contact with the sick and their effects is chiefly due to Jacobo della 
 Torre, known also by the name of Jacopo da Forli, from the name of 
 a city in central Italy, where he was born in the second half of the 
 fourteenth century. Contagion had been referred to obscurel}^ and 
 timidh^ from Aristotle down, but now the idea took a practical form. 
 The old notion was that fomites were a sort of tinder that caught from 
 the air an infection existing independently of the sick. Many writers, 
 including Galen, believed there was an extreme degree of atmospheric 
 pollution in the vicinity of the sick, rendering such neighborhoods 
 dangerous, but this was considered a primary cause of the illness rather 
 than a direct emanation from the sick. 
 
 Delia Torre's doctrines were not accepted by the various schools of 
 medicine and were for a time absolutely forgotten. Fracastoro pro- 
 claimed the same theories at a later period, when they were better 
 received, and to him is generally given the honor of announcing the 
 theoiy of contagion. Jacobo della Torre advised the magistrates of 
 his native town to remove outside the city all persons affected with 
 pest and to isolate them, as well as all persons who had been with 
 them. The authorities were warned against delay, for it was avowed 
 that every precaution would be futile should the disease become dif- 
 fuse throughout the city. In his recommendations no mention is made 
 of purification, but he asserted his disagreement from the accepted 
 belief in the stellar origin of the infective principle. Della Torre's 
 disciple, Michele Savonarola, attained greater eminence than his mas- 
 ter, and so far vindicated the honor of his school as to declare that even 
 persons in good health may transport the pestilential virus to distant 
 places, and that those who are not brought in association with the vic- 
 tims of pest or with pest-bearing things escape the disease. But 
 Savonarola did not fully indorse the teachings of his preceptor. He 
 could not shake oif a belief in astrology and admitted that the origin 
 of pest resided in a disorder of the air generated in consequence of 
 planetary contact. 
 
 Giovanni da Concorrezzo, toward the second half of the fourteenth 
 century, was so profoundly convinced that pest came exclusively from 
 universal aerial pollution that he denounced as useless every precaution 
 to check the advances of the disease and affirmed that all measures 
 designed to avert contagion are inefficacious. 
 
 At this period, when the world had about decided that in epidemics 
 sanitation was not worth while, three observing men lent their influ- 
 ence to broader views and thus gave a potent stimulus to the doctrine 
 of contagion. These writers were Alessandro Benedetti, Marsilio 
 Ficino, and Gerolamo Fracastoro. 
 
12 
 
 BENEDETTI AND FICINO. 
 
 Alessandro Benedetti, anatomist and military surgeon, wrote a 
 treatise on pest, published in the last decade of the fifteenth century, 
 in which is presented a resume of his doctrine concerning pest. 
 Pest, he declared, is not only catching by contact with the sick, but 
 by fomites. The latter, he believed, are capable of receiving and pre- 
 serving the contagion for long periods. Convalescents from pest, 
 and the things that have been in relation with them, should, he said, 
 be purified before being brought in touch with healthy persons. 
 
 Marsilio Ficino was born in Florence in 1433, and passed his child- 
 hood in the court of Cosmo de' Medici. He was a priest as well as a 
 physician. Pest had, in Ficino's time, tormented Tuscan}", and in 
 11T9 broke out in Florence. The Grand Duke Cosmo de' Medici 
 requested Ficino to prepare a book treating of the pest with the scope 
 of instructing the people how to protect themselves from the scourge. 
 The book, published about 1180, was written in Italian. In writing 
 it, Ficino was associated with Tommaso del Garbo, Mengo da Faenza, 
 and others, and the volume bore the title of Counsel Regarding the 
 Pest. The book is a rare one in its original tongue, but fortunately 
 was translated into Latin and is still x^reserved in different libraries. 
 The list of the works of Ficino refers to this treatise by the title of 
 Antidotus, and it is so cited in many medical books printed in later 
 years. The theories given in this work as to the origin and nature of 
 epidemic disease are the same fantastic stuff' that antecedent writers 
 dealt out, but the ideas as to how the disease may be imparted are of 
 a much better sort. The view is advanced that pest can be communi- 
 cated from man to swine, and that cats and dogs convey the disease. 
 The reader is informed that pestilential poison may abide in the air 
 for long periods and may infect food. Advice is given to boil all 
 drinking water, or to impregnate it with iron rust; to dilute wine 
 with water so prepared; to add an acid sauce to the food; to choose 
 dry food and fruit grown in balsamic and elevated regions, and to 
 dwell on hills or in the mountains. Treating of prophylaxis and die- 
 tetics during times of pest, there is a long list of injunctions relative 
 to exercises of the body and the quality of the food. For example, it 
 is enjoined to shun the heat of the sun and of tires; to avoid sweating 
 and the drving of sweat on the bod}-; not to eat fish, or if needs be, 
 to eat small fish from some clear running stream with a rocky bed, 
 and to fry them in oil and treat them liberally with lemon juice, pep- 
 per, and cinnamon; and, lastl}^, there is an enumeration of fruit and 
 vegetables to be chosen or avoided. Overeating and overdrinking are 
 admonished, and it is advised to cook all meat well and prepare it with 
 aromatic condiments. To preserve the health of those in attendance 
 
13 
 
 on the sick, it is directed to keep as far apart as may be from the bed- 
 side; to ventilate the sick rooms; to fumigate the house with burning 
 terebinth wood; to carry in the hand a firebrand, a pot of lighted 
 charcoal, or a sprig of rue, mint, sage, or myrtle; and to bathe the 
 body, morning and evening, with warm vinegar. Directions are 
 o'iven to sprinkle the house with preparations of terebinth, juniper, 
 sandal, rose, rosemary, laurel, and similar herbs. The reader is 
 informed that walls, partitions, and all structures made of wood are 
 capable of preserving the contagion for more than a year, and that 
 their disease-bearing qualities should be corrected by washing, fumi- 
 gations, and fire; that garments of wool and similar stuffs, if not 
 exposed to the air and sun, fumigated often, and well washed, may 
 still contain contagion after three years. The statement is made that 
 the morbid principle can difiuse itself through division walls and 
 enter neighboring habitations. Caution is prescribed in moving ani- 
 mals, money, furniture, and bundles from place to place because of 
 the danger of conveying disease. 
 
 FRACASTORO AND SYPHILIS. 
 
 Gerolamo Fracastoro is generally credited with being the author of 
 the theory of contagion, but, as has been seen from a review of the 
 works of previous writers, it can only be claimed for him that he 
 elaborated the theory, presented it in a popular form, and lent to the 
 idea the influence of his high authority. 
 
 An important event at this period of history was the extensive prev- 
 alence of syphilis in Europe, a spread of the disease that gave it 
 every likeness to a general pestilence. The chroniclers of this occur- 
 rence were convinced that the disease could propagate itself at a dis- 
 tance, and that it could be communicated by intercourse not more inti- 
 mate than conversation and social commingling. The malady diffused 
 itself through all classes of society, and history names a king and 
 other potentates among the victims. In Italy the belief prevailed 
 that the disease had gained access to the country with the invading 
 army of Charles VIII, of France. The Italians called it the "morbo 
 Gallico." In France it took the name of the Neapolitan disease. 
 Wide credence was gained by another theory to the effect that the 
 malady had come in by sea with the naked savages of America. In 
 this case it must have spread and taken root verj^ speedily, for it is 
 said that when Columbus went to Barcelona on his way to pay homage 
 to Ferdinand and Isabella, of Spain, syphilis flourished in that seaport; 
 public prayers were being offered as in times of pest, and precautions 
 were being taken against the disease as in case of leprosy. 
 
 Laws were made in France for the regulation of syphilis. By an 
 act of the Senate at Paris, dated March 6, 1496, persons affected with 
 
14 
 
 the disease were forbidden under pain of the halter to have any deal- 
 ings with well persons, and it was ordered that the sick should be seg- 
 regated in places set aside for their reception in the Faubourg St. 
 Germain. Notwithstanding the rigor of the ordinance, many stricken 
 persons eluded the vigilance of the sanitary guards and moved about 
 in the city of Paris, thereby spreading the disease. The provost then 
 found it necessary to make public cr}", warning all persons that there- 
 after pretensions of ignorance would be disregarded by the authori- 
 ties, and any individual, native or stranger, afflicted with syphilis and 
 found within the city would be summarily cast into the river and left 
 to his fate. 
 
 Some years later there was similar trouble in the Italian part of the 
 Tja'ol, trouble which so interfered with one of the most important 
 ecclesiastical gatherings of the times that Pope Paul III, by advice of 
 Fracastoro, removed the Council of Trent to Bologna. Fracastoro 
 had previously written a dignified and graceful medical poem, in 
 Latin, entitled "Syphilidis sive Morbus Gallicus," after whose hero, 
 the shepherd Syphilus, the disease received its name. 
 
 His interest in this prevalence of syphilis influenced Fracastoro to 
 publish, in 154:6, the work "De Contagionibus." The great feature 
 of this writing is the presentation of the subject in such a catching 
 wa}^ that it took hold on the jjopular mind, and even had decided ejffect 
 in loosening the deep-rooted medical opinion of the times. The lesson 
 of contagion was taught by a number of clever similes. For example, 
 Fracastoro divides contagious diseases into three classes, namely, dis- 
 ease catching by contact, in which he compares the mode of com- 
 municability to the way in which one decaj^ed fruit spoils another 
 perfect one; disease carried by fomites, a process likened to the per- 
 sistence of soot on a smoky wall; and disease conveyed to a distance, 
 in which manner the virus is carried just as the volatile essence of 
 garlic or of an onion is borne through space, affecting the nostrils and 
 causing the eyes to water. Fracastoro taught that the poison of dis- 
 ease consists in corpuscles, and that it affects first the minute particles 
 of the animal body. - He saj^s that this poison persists in the body, in 
 fomites, or in the air, in proportion to a kind of stickiness existing 
 between the conveying medium and the poisonous corpuscles; and 
 that woolen fabrics and the like absorb, retain, and transport con- 
 tagion with ease, because they contain interspaces to lodge the cor- 
 puscles, and are of a nature to protect the poison from the light, heat, 
 cold, air, dampness, and other conditions injurious to it. 
 
 So we see that, with the acceptance of the views of Delia Torre, 
 Benedetti, Ficino, and Fracastoro, things were fairly in the way for a 
 beginning of quarantine on a practical basis. 
 
15 
 
 MARITIME QUARANTIJfE. 
 
 Maritime quarantine originated in connection with the Levantine 
 trade. Its early history is associated with that of shipping in the 
 Mediterranean, especially with that of the traffic of Venice, Genoa, 
 and Marseille. Although commercial activity in these waters was 
 initiated by the Phoenicians, the maritime pioneers, records of disease 
 introduced hj sea are not found bearing earlier date than the period 
 when Koman navigation was well established. As has been seen, the 
 practice of isolation was first applied against communicable disease by 
 the Hebrews, but their lazarettoes, it appears, were little used in con- 
 nection with foreign trade, leaving out of the question commerce by 
 sea. In the exchange of commodities with foreign countries the 
 Hebrews were largely dependent on the Phoenicians and Arabs. Had 
 the Jews been active in outside commerce, we should probably read in 
 the Old Testament of sanitary laws applicable to caravans and vessels. 
 
 As has been already mentioned, Pliny implies that leprosy was 
 introduced into Europe b}' Pompey on his triumphal return from the 
 East. It is altogether probable that the Koman ships, laden with spoil 
 from Syria, and bringing many prisoners of war to Italy, carried in 
 leprosy. 
 
 In connection with the question of the first recorded introduction of 
 disease by sea a curious error has entered into writings on the subject. 
 J. Freind, adducing evidence in his History of Medicine that Procopius 
 was a physician, quotes a translation of Procopius's works by Dr. 
 Howel, and says that the great Byzantine historian describes the pest 
 at Constantinople (A. D. 534) as having originated at Pelusium, in 
 Egypt. This is indeed what Procopius wrote. But it happens that 
 later writers — evidently reading Freind's history — say that Procopius 
 states the epidemic in question was carried to Constantinople by ships 
 and that this invasion of disease became later the foundation of the 
 quarantine establishments on the Mediterranean coast. It is, how- 
 ever, true that the Italian epidemics of the sixth centur}'- began in the 
 maritime towns and thence spread inland; but it does not follow that 
 the writers of the time considered the intervention of ships essential 
 to the introduction of disease by sea. For example, Francesco Alfano, 
 professor of medicine at the University of Salerno, which in those 
 days was reputed to be the greatest medical school in the world, 
 writing in 15T7, says that the corrupt air capable of introducing pest 
 may be blown over sea and land for long distances; otherwise how 
 could it be explained, he asks, that pest was transported from Ethiopia 
 to Athens and to all Attica? It was considered, moreover, that a ship 
 might easily be pestridden. Even by going to sea a vessel with all 
 well aboard at the time of departure could not alwa3^s escape the 
 
16 
 
 scourge. The infection extended over the water. Matteo Villani, of 
 Florence, writing in 1581 of the epidemic of 1346, which spread from 
 Asia into Turkey, Egypt, Russia, Greece, and Italy, says that in those 
 evil days numbers of Italian galleys flying from the pest left the 
 stricken ports for healthier harbors. Their crews perished miserably 
 at sea. Some reached Sicily, Pisa, and Genoa, and the disease went 
 with them. 
 
 EARLY MARITIME SANITARY LAWS. 
 
 There is but little known of ancient laws relating to maritime com- 
 merce, and even this little was lost to the world until 1117. The story 
 is an interesting one. Justinian, during his reign, confided to ten juris- 
 consults the task of collecting and adjusting the numerous Roman laws, 
 together with the various sentences and rulings of judges and magis- 
 trates. A compendium of these documents and of the laws promul- 
 gated during the rule of Justinian was published. It is known by the 
 name of the Codex of eTustinian. The only part of this code that 
 treats of ships is called the Digestum, and it was lost for hundreds of 
 years. Finally, in 1117, the papers were discovered at Amalfi and 
 made public. The Digestum treats of the reciprocal rights of the 
 owners and renters of ships, but no mention is made of sanitary mat- 
 ters. During the long period when this important legal instrument 
 was lost, the Venetians, Genoese, and other Latin maritime nations 
 supplied the deficiency in part from the initial sources of Roman law 
 and in part by custom and agreement. Of this sort are two collec- 
 tions, one known by the name of Hecognoverunt Proceres and the other 
 called the Consolato del Mare. Besides these, there is a great number 
 of documents, such as constitutions, decrees, ordinances, sentences, and 
 the like, which pertain to maritime rights. It is a remarkable fact 
 that, notwithstanding the detailed attention given to most maxims. 
 relating to shipping, the Hecognoverunt and the Consolato del Mare 
 are silent too on the subject of sanitation. Therefore, in the Middle 
 Ages, in event of contagious prevalences, it rested with each individual 
 cit}^ or country to make such provisions as were deemed opportune. 
 Such an edict is the one, said to be the most ancient of its kind, already 
 mentioned as having originated at Reggio d'Emelia, in 1371, and com- 
 manding notification and segregation of cases of plague. 
 
 The Venetians were, it is generally admitted, the first to make pro- 
 vision for maritime sanitation. As far back as the year 1000 there 
 were overseers of public health, but at first the office was not a per- 
 manent one. The incumbents were appointed to serve during the 
 prevalence of an epidemic only. The first information we have of this 
 kind of public office is under date of 1318, when Nicolaus Venerio, 
 Marinus Querino, and Paulas Belegno (their Christian names given in 
 the Latin of the text) were appointed overseers of public health. 
 
17 
 
 These officers were authorized to spend public money for the purpose 
 of isolatino- infected ships, goods, and persons at an island of the lagoon. 
 A medical man was stationed with the sick. As a later result of these 
 arrangements, the first thoroughly constituted maritime quarantine 
 station of which there is historical record was established in 1403 on 
 the island of Santa Maria di Nazareth, at Venice. The island had pre- 
 viously belonged to the hermit monks of the order of St. Agostino. 
 The record of the foundation of the first maritime quarantine is found 
 in a Venetian manuscript written by Giovanni Tiepolo, a patrician. 
 The chronicle reads: 
 
 1403. The pest began at Venice. A place for a lazaretto was seized from Friar 
 Gabriel, of the order of Hermits, and Santo Spirito was given to him. 
 
 Neighboring States engaged in commerce in the Mediterranean 
 speedily followed the example of Venice. The first maritime quar- 
 antine station at Genoa was founded in 1467, and at Marseille in 1526. 
 The Marseille quarantine, one of the most complete of its kind, occu- 
 pied the island of Pomique. This establishment had, in former times, 
 been a leper house, but, in 1476, was converted into a plague hospital, 
 and later became a maritime quarantine station. 
 
 It was not until 1459 that a public bureau of sanitation existed in 
 the Republic of Venice. In that year officers, called conservators of 
 sanitation, were regularly appointed. This information was handed 
 down by a contemporary seafarer, Ser Domenico Malipiero, a Vene- 
 tian patrician, an expert in commerce and diplomacy, who, in 1488, 
 commanded the men-of-war under Captain-General Ser Jacopo Mar- 
 ceUo at the celebrated naval battle of Gallipoli. In the contest against 
 the Ottoman fleet the captain -general was killed, and Malipiero (who 
 had a grade relative to that of vice-admiral at the present time) took 
 command and was victorious. Malipiero wrote certain annals of his 
 life which he bequeathed to his son-in-law. This interesting diary, 
 in Venetian dialect, remained secret until 1844, when it was published 
 in the Italian Historical Archives. 
 
 The city of Barletta became at one period of the Middle Ages the 
 richest commercial port, next to Venice, in the Adriatic. This was 
 owing to certain concessions granted the city whereby the traffic of a 
 large territory was compelled to enter and leave by her gates. The 
 privilege was not without its drawbacks, Barletta underwent three 
 pestilences of a particularly aggravating character. The first, in 1384, 
 was a strange malady that caused the sufferers to lose their skins like 
 a molting snake. The other two epidemics (1498 and 1656) were 
 probably bubonic plague, and in the last 35,000 souls, almost the 
 entire population of the city, perished. These afflictions gave rise to 
 the practice at Barletta of absolutely refusing entry to any infected 
 vessel until the expiration of a long period of observation at a place 
 outside the entrance of the port. 
 
 21526— No. 12—03 2 
 
18 
 
 During all this period land quarantines were in operation at times of 
 pest. Offenses against quarantine, both land and maritime, were 
 severely punished. Pietro FoUerio, a great Neapolitan jurisconsult 
 of the sixteenth century, mentions whipping, the mill, exUe, and death 
 as penalties for infringement of sanitary regulations. A quarantine 
 proclamation and command made by Don Carlo d'Aragona imposes 
 rigorous punishment for surreptitiously entering the cit}^ of Palermo 
 during a prevalence of pest. Torture, long service in the galleys, and 
 work among the sick in a pest hospital are named among the penalties. 
 Even the nobles were subject to heavy fines and long imprisonment in 
 the castle. 
 
 BILLS OF HEALTH. 
 
 Sanitary bulletins were incident to quarantines and cordons. They 
 were so called because they were stamped with the '' boUo" or seal of 
 the authority issuing them. When the system of sanitary bulletins was 
 fully developed these patients, in their connection with ships, were 
 designated as clean, when beyond suspicion; touched, when from a 
 noniufected place in active communication with infected places; sus- 
 picious, without sickness aboard, but having received goods from 
 places or from ships or caravans from places where pest prevailed; and 
 dirty, when from a place where disease existed. 
 
 Professor Bo, a member of the council of health of Genoa, in mak- 
 ing researches relative to ordinances of sanitation proclaimed in 
 France in 1850, found an interesting document in the archives of the 
 " Conservatori di Mare di Genoa," a body of officials to whom in 
 mediaeval times was confided the vigilance over public health. This 
 writing, dated 1300, makes mention of bulletins of health [hullettones 
 sanitatis) with which ships from the littoral of Corsica and Sardinia 
 were required to be provided. Prior to 1300 there is a record in a 
 rubric of the statutes of the city of Urbino, Italy, in which, referring 
 to precautions against pest, it is written that no person shall leave the 
 gate of the cit}' without a proper bulletin, and that, to this end, watch 
 shall be kept day and night at the city gates and walls. During the 
 pest at Naples, in the year 1557, citizens, usually merchants, were 
 stationed at the gates of the city to examine bills of health. Cor- 
 ruption and lack of diligence on the part of these persons were pun- 
 ishable by death. Sentinels, some on foot and some on horseback, 
 made a patrol about the cit}' walls to prevent clandestine entrance. 
 Bills of health to be acceptable had to be stamped with the seal of the 
 university of the place from which the traveler came. They gave not 
 only the day but the hour of departure, together with a description of 
 the traveler. Sanitary bulletins were also issued to accompany mer- 
 chandise, but in times of severe pest all articles except aromatics and 
 medicaments were considered suspicious. The facts here given are 
 
19 
 
 taken from the instructions written by Pietro Follerio, an eminent 
 jurisconsult, who was assigned by the viceroy of Naples to superin- 
 tend the province of Campania during the prevalence of pest with the 
 special duty of indicating means for the betterment of public hygiene. 
 It is worthy of notice that the provisions of public sanitation in those 
 times are usually" found, not in books of medicine, but in treaties on 
 jurisprudence. This is explained by the fact that the medical pro- 
 fession was looked to for scientific indications onh^, and that the appli- 
 cation of sanitar}" measures founded thereon, limiting or compromising 
 as they often did the rights of the public or the constitutional privi- 
 leges of citizens, was a matter for legal consideration and action. 
 
 AN EAELY SANITARY CONGRESS. 
 
 The efforts of some of the pioneers of quarantine were at times ill- 
 advised, did not always meet with general approval, and sometimes, 
 indeed, occasioned strong outbursts of popular indignation. The 
 experience of Girolamo Mercuriale (called the ^sculapius of his 
 time) and of his colleague Capodivacca is an instance. In the summer 
 of 1576 the frequence of strange febrile diseases, often very mortal, 
 was observed at Venice. The supreme magistrate of health of the 
 Republic of Venice, suspecting pest, called a conference of great 
 physicians, among others Girolamo Mercuriale, Capodivacca, and 
 Nicola Massa. As for the verdict Massa wavered, and the other mem- 
 bers were divided into two camps, one body for and the other against 
 pest. Mercuriale and Capodivacca asserted decidedly that the malady 
 was not pest, but an epidemic of fever, due to the excessive heat of the 
 season. This opinion carried the day, and no precautions were taken 
 against the spread of the disease. Unfortunately for the optimistic 
 diagnosticians, the illness increased, and speedily took on all the 
 characters of pest. The populace uprose and made an effort to lynch 
 Mercuriale and Capodivacca and burn their houses. Both the physi- 
 cians, fortunately for them, escaped by flight, their property being 
 saved by prompt action of the authorities. 
 
 EARLY EFFORTS AT DISINFECTION. 
 
 The armament of disinfection in early days was full of oddities. 
 In the process of purification time was more trusted than anything 
 else. Gian Filippo Ingrassia, appointed by Philip II of Spain to 
 establish a public sanitary service in Sicify, begins his book on pest 
 and contagious disease with the following distich by Martello: 
 
 liana, aura el linum captant contagia pestis; 
 Ignis, furca, anrum sunt medidna mali. 
 
 Before reviewing the different means besides fire, the gallows, and 
 money used- against contagion, it is interesting to make a survey of 
 
20 
 
 the things, in addition to wool, the air, and garments, that were reck- 
 oned infectible. Animals were considered capable of conveying dis- 
 ease. During the pestilence at Palermo in the year 1576 Ingrassia 
 caused all the dogs in the city to be brought together alive on a cer- 
 tain day and cast into a common pit, where they were covered with 
 quicklime and then with earth and stones. As to cats, they were 
 allowed to live, so as " not to have worse war with rats," says Ingras 
 sia, but all cats that had been near suspected houses were required to 
 be kept closed up. There were similar restrictions for fowls and pig- 
 eons. Elsewhere geese and cattle were banished from the cities dur- 
 ing epidemics. Habitations, ships, and even the sails and cordage 
 with which vessels were rigged belonged to the categor}^ of infectible 
 things. Nicola Massa, a Venetian physician, who published in 1556 
 a book on pestilential fevers, names the following as fomites: Wool, 
 hair, cotton, linen, hemp, silk, thread, and all things made from these 
 substances; skins, feathers, and the like; and all merchandise, as well 
 as sacks, baskets, boxes, casks, and cords that cover them. Massa 
 considered as noninfectible all metals and objects made of them, 
 including arms and cooking utensils; precious stones and marble; 
 grain, flour, and meal; vegetables, fruit — fresh and dried — and nuts, 
 wine, oil, and vinegar; and all drugs and aromatics. In regard to 
 metallic money he said that those who held it in suspicion might allay 
 their fears by receiving it in a vessel of vinegar. 
 
 Exposure for many days to the air in selected places and to the dew 
 was looked upon with great favor. The dew of the dead of night was 
 supposed to be particularly efficacious. This practice originated in 
 the more or less accurate observation that during the season when the 
 mists of the Nile were thickest the pest in Lower Egypt began to 
 diminish. 
 
 The vapors of volatilized aromatic substances, known technically as 
 "perfumes," were credited with great virtues in correcting the alter- 
 ation of the air generated by pest. Cloves, cinnamon, cedar bark, 
 camphor, mints, resinous wood, and similar substances were kept boil- 
 ing in pots of vinegar and rosewater for long periods. One recipe 
 containing garlic and known as the "vinegar of the four thieves" 
 enjoyed high repute. Fumigations in summer difl^ered from those in 
 winter. Aromatic wine was added in fumigations for cold weather, 
 being assumed to have a special property of correcting air at a low 
 temperature. It was also considered advisable to lengthen the period 
 of isolation in winter because cold was thought to have a tendency to 
 conserve the contagious principle. Sulphur fumigation was not 
 regarded with favor in earl}^ days. The strong sulphurous fumes 
 were said to alter the air unfavorably rather than rectify it; but sul- 
 phur came more into vogue in the eighteenth century. The burning 
 of gunpowder was also thought useful. 
 
21 
 
 Huge fires, kept burning for weeks, were used from the most ancient 
 times. The physician Acron is reputed to have rendered great service 
 by the use of fires at Athens during the pest at the beginning of the 
 Pelopennesian war. Fires made of shavings and chips were thought 
 preferable, because they produce a clear flame, without smoke. Aro- 
 matic wood was added to these fires, but special caution obtained 
 against burning an3^thing producing an offensive odor, such as the 
 wood of certain nut trees, for fear of liberating vapors likely to add 
 to the disturbed condition of the air. Not only were garments and 
 similar articles burned, but sometimes houses and ships as well. Oppo- 
 sition often existed against such measures on the ground of further 
 deteriorating the atmosphere. 
 
 Mixtures of lime were favorably regarded and whitewashing of 
 infected apartments was habitually practiced. Acid fumigations are 
 spoken of in the eighteenth century. Muriatic acid fumes, suggested 
 as a disinfectant in 1T74 by Guyton Morveau, of Paris, were used in 
 1800 to disinfect rooms, garments, mattresses, and the like, after the 
 epidemic of yellow fever in Spain ("Yellow fever in Spain," Yellow 
 Fever Institute, United States Public Health and Marine-Hospital 
 Service, Bulletin No. 6). With all these measures, great stress was 
 laid in cleaning up infected cities during and after epidemics, giving 
 special attention to sewers, wells, cesspools, and disposing properly of 
 dead bodies. In reading the chronicles of the middle ages the con- 
 viction can not be avoided that, were it not for occasional epidemics, 
 public sanitation would have fallen entirely into disuse. 
 
 MEASUEES ADOPTED IN A PEST-STRICKEN CITY. 
 
 To gain a precise knowledge of what measures were usually prac- 
 ticed in places afflicted with an epidemic in early days, it is instructive 
 to examine specifically the provisions adopted in a particular city. A 
 suitable instance is presented in the Treatise on Plague, by Alessandro 
 Massaria, who was in charge of sanitary measures at Vicenza, Italy, 
 during a prevalence of bubonic plague of one year's duration in 157Y. 
 The first death was attributed to garments clandestinely introduced 
 from Padua, where plague prevailed. After a necropsy establishing 
 the diagnosis the furniture in the house was burned and every exposed 
 person stripped, given new clothes, and removed outside the city. 
 The house was purified by aromatic fumigations and painted with 
 milk of lime. All infected vestments and bedding received a treat- 
 ment with strong lye. The disease, however, spread, and in one year 
 the city, with a population of 30,000, suffered 1,908 deaths from plague. 
 As soon as the epidemic established itself the city was divided into 32 
 sections and a daily house-to-house inspection made by 64 trustworthy 
 citizens, two to each precinct. All cases of sickness were reported to 
 one of four public physicians. These physicians served for periods of 
 
22 
 
 fourteen daj^s. Infected habitations received the same treatment as in 
 the initial case, except that the furniture was not burned in all 
 instances, but washed instead with lye and left in the sun and open air 
 for thirty days. All garments were put in running water for two 
 days. Persons exposed or under suspicion went to the Campo di 
 Marte, outside the city walls, where wooden houses had been built. 
 A river separated the isolation camp from the lazaretto, where the sick 
 were lodged and where physicians and nurses were in attendance. 
 Suspects developing plague in the isolation camp were taken across the 
 river to the lazaretto, and convalescents from the latter place were 
 transferred to the former. Those who kept well in the Campo di 
 Marte for twenty-two days returned to their disinfected homes in the 
 city, there to remain under observation for an additional twenty-two 
 days. Convalescents from the lazaretto passed twenty-two days in 
 the isolation camp, and were afterwards confined to their houses in the 
 city for another twenty-two days. At the height of the epidemic all 
 the houses in the city were closed for forty days, and none but the 
 guards were allowed in the streets. At this time 5,000 persons were 
 fed from public funds, and there were about 400 persons in the lazaretto 
 and 500 on the Campo di Marte. 
 
 EAELY MAKITIME QUARANTINE STATIONS. 
 
 The maritime quarantine stations of the sixteenth century consisted 
 of an anchorage, barracks for suspects and convalescents, and a place 
 where purification could be applied. The practice, with obvious modi- 
 fications, was the same as in the case of an infected city. The person- 
 nel of these stations consisted in many places, at the earliest times, of 
 surgeons and their assistants, for plague, being regarded as a surgical 
 disease, did not fall clinically into the hands of physicians. At a later 
 period the physicians conducting the stations were aided by surgeons, 
 barbers, and experts in aromatics, because, as Massa says, the physi- 
 cians were so limited in their acquirements as not to know how to do 
 manual operations or treat external maladies. 
 
 With a view to learning how the various methods of disinfection 
 were practically applied at early maritime quarantine stations, it will 
 be interesting to relate what was done to a Catalan ship that arrived 
 at Palermo from Barcelona on the way to Naples at the time Ingrassia 
 was chief of sanitation in Sicily. The account at least shows that the 
 sanitarians of the sixteenth century were thoroughgoing. This vessel 
 had 97 persons aboard, 18 of them passengers. Three seamen and 
 two passengers had died of a disease suspected of being pest. The 
 deaths occurred while the vessel was taking on cargo in the harbor 
 where she lay at anchor. The cargo consisted of barrels of salted fish, 
 cases of sugar (destined for Palermo, and already disembarked and in 
 
23 
 
 store), salted cheese, salt in bulk, a quantity of sumac, and merchan- 
 dise, including many bales of cloth from Barcelona, a port not under 
 suspicion. The master of the vessel was at once required to give 
 20,000 scudi security not to leave the harbor until given pratique. To 
 make assurance doubly sure, the rudder was taken away from the ship 
 and a watch set. All persons, except the sick and a sufficient number 
 of seamen to guard the ship, were sent ashore to a place known as the 
 Borgo, where all garments were taken from them and they themselves 
 exposed to the fumes of boiling pitch and afterwards washed with 
 vinegar. Some of the clothing was burned and some washed, aired, 
 and perfumed for fifty days. 
 
 The sick were sent to a lazaretto, the Cuba, a huge stone building, 
 which still stands at Palermo as a monument of early quarantine. 
 
 The treatment given the cargo was as follows: Barrels of salted 
 fish, washed outside, first with sea water and then with vinegar; cases 
 of sugar, salted cheese, and sumac, coverings removed and burned 
 and the commodities without further treatment delivered to the owners; 
 salt, no treatment, not being considered infectible; merchandise, aired 
 and perfumed ashore for 60 days, and the cloth unrolled and hung 
 from the rigging of the ship for 50 days. The sails and cordage of 
 the ship were taken down, submerged in the sea for a week, and then 
 hung from the masts, yards, and booms in the air, sun, and dew, by 
 day and night, as long as the ship remained in quarantine. Fumiga- 
 tion was made in the interior of the ship by boiling pitch in caldrons 
 between decks. Fifty days were set as the period of detention, 
 instead of forty, because the season was winter. 
 
 FUETHER HISTORY OF QUARANTINE. 
 
 Without touching on quarantine in America, which is another and 
 interesting story, it is profitable to take a view of the further history 
 of quarantine in Europe. Following the discovery by Anthony van 
 Leeuwenhoek, in 1675, of bacteria, called by him "animalcules," there 
 was a wide belief in the casual connection of microscopic creatures 
 with disease, a belief supported by the doctrine of living contagion 
 enunciated by Marcus Antonius Plenciz, of Vienna, in 1Y62, but it 
 was without marked effect on quarantine procedure. The theory, in 
 fact, lost hold on the public and medical minds to such an extent that 
 in the early part of the nineteenth century the doctrine of a living 
 contagion was looked upon as an absurd assumption. It was not until 
 the middle of the last century, following the investigations of Pasteur, 
 PoUender, and Bavaine, that quarantine practice became established 
 on its modern scientific basis. 
 
 English quarantine procedure prior to 1800 did not difl^er much 
 from that of the Mediterranean ports. English vessels, which did 
 
24 
 
 not begin to enter the Mediterranean until the time of the Crusades, 
 were usually, in earl}^ 3'ears when engaged in the Levantine trade and 
 from infected ports, sent to Mediterranean quarantines for treatment. 
 In 1710, under the reign of Queen Anne, a rigorous quarantine act 
 was passed in England, and in 1721 two ships with cargoes of cotton 
 goods from C3^prus, where plague prevailed, were burned by the san- 
 itary authorities in English waters. A quarantine station was estab- 
 lished in 171:1 in Stangate Creek, on the Medwa3^ Here vessels, not 
 treated at Mediterranean quarantines, were submitted to practically 
 the same procedures as were in vogue at French and Italian ports. 
 Floating hulks were also used as quarantine stations in England from 
 about the middle of the eighteenth century. The act of Queen Anne's 
 reign was qualified by later enactments, and during the pest in Poland, 
 in 1780, vessels bound for England from the Baltic were compelled to 
 undergo a typical old-fashioned quarantine. A few years later there 
 was an order in effect directing all vessels on the way to England and 
 liable to quarantine to show a j^ellow flag at the mainmast head when 
 in sight of other vessels at sea during the day and a distinctive light 
 at night. From the beginning of the nineteenth century quarantine 
 restrictions were, by changes in the laws and their application, materi- 
 ally relaxed in Great Britain, and as a substitute for former practice 
 it has not been the custom in modern times to detain any vessel unless 
 there has been communicable disease aboard during the voyage, or 
 such exists on arrival. Following the decision of the Spanish Govern- 
 ment in 1821, that yellow fever was to be considered quarantinable, 
 an inquiry on the subject was made in England in 1823 and 1824, 
 which resulted in the passage of a law directing the same procedures 
 to be applied against yellow fever as against plague. 
 
 In France, until the year 1821, vessels from the Levant were not 
 allowed to enter at any ports except Marseille and Toulon. The 
 sanitary regulations of these ports were fortified b}^ royal edicts. 
 With the appearance of yellow fever on the frontier of Catalonia in 
 1821, an appalling epidemic that spread from Barcelona and killed 
 25,000 people in five months, a law was passed by the French Cham- 
 bers, March 5, 1822, making a uniform sanitary code for all France, 
 which, with certain subsequent modifications, fomied the basis of 
 French maritime sanitary practice. 
 
 Quarantine in the different continental European maritime countries 
 during the eighteenth century was practically on a uniform basis, and 
 during the first half of the succeeding century quarantine w^as prac- 
 ticed on the same lines in all European countries engaged in Eastern, 
 American, and African trade, England excepted. 
 
 The international sanitary conferences at Paris in 1851 and 1852, in 
 which participated the different European powers having interests in 
 the Mediterranean, marked the close of the old regime of quarantine. 
 
25 
 
 Delegates were present from France, Austria, the two Sicilies, Spain, 
 the Roman States, Greece, Portugal, and Turkey. England was not 
 signator3^ Regulations were adopted much less restrictive than former 
 ones, it being admitted that the efficacy of many measures formerly 
 practiced was doubtful or negative, science having proclaimed that, for 
 the most part, pestilential maladies are not contagious. This surpris- 
 ing declaration was followed by a revolution in quarantine methods on 
 the Continent and resulted in the general adoption of practices based 
 on the limited communicability of epidemic diseases. These changes, 
 with which the early history of quarantine closes, were brought into 
 effect at the beginning of the new era, during which the doctrine of 
 specific living causes of epidemic diseases have been built up on the 
 substantial basis of experimental medicine. 
 
 ACKNOWLEDGMENTS. 
 
 For assistance in collecting data for the early history of quarantine, 
 acknowledgments are due to Dr. Enrico Buonocore, of Naples, and 
 to the librarians of the public libraries of Naples and Palermo. 
 
 BIBLIOGRAPHY. 
 
 [The whole title-page of many of the works cousulted and some subtitles are given because of the 
 interest attaching to the writings as doctunents in which the early history of quarantine is pre- 
 served.] 
 
 Historiee Ecclesiasticse Scriptores Grteci. Colonic AUobrogrum. Petrus de la 
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 Jacobi Foroliviensis, medici singularis. Expositio et quaestiones in primum cano- 
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 Muratori, Rerum Italicarum Scriptores. Vol. 18. Milan, 1731. The edict of Reg- 
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 Tractatus singularis doctissimi viri Marsilii Ficini de epidemise morbo, ex italico in 
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26 
 
 loannig Fernellii, Ambiani. De abditis rerum causis. Libri duo postremo ab ipso 
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27 
 
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