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Quarantining Ships In the Golden Age of Piracy, Page 5

Bubonic Plague: Mediterranean - (A Very Brief) History of Regulations

Some of the history of quarantine implemented to prevent the bubonic has more to do with land-based quarantine than it does ship-based.
Artist: William Brassey Hole - Outcast Biblical Lepers (c. 1925)
Several authors point to the Bible, particularly Moses' command to Aaron to have a priest determine who had leprosy and then "shut up him that hath the plague, seven dayes. And the Priest shall looke on him the seventh day: and beholde, if the plague in his sight be at a stay, and the plague spread not in the skinne, then the Priest shall shut him up seven dayes more."¹ If the person still had signs of leprosy after that, they were declared unclean, were to "dwell alone, without the campe shall his habitation be."² Further instructions to quarantine lepers can be found in the bible in Numbers and the first book of Samuel. However, the Hebrew "lazarettoes, it appears, were little used in connection with foreign trade, leaving out of the question commerce by sea. ...Had the Jews been active in outside commerce, we should probably read in the Old Testament of sanitary laws applicable to caravans and vessels."³ Still, the Mediterranean plague quarantines worked along similar lines, although the period of quarantine was longer.

It was not until the fourteenth century were that the type of quarantine still in use during the golden age of piracy began to form. The fairly standard period of quarantine may have begun when "the Knights Hospitallers of the Order of St. John of Jerusalem first adopted a forty-day quarantine after their establishment on the island of Rhodes in 1306."⁴

Decades later, following an outbreak of bubonic plague in Ragusa (in what is today Dubrovnik, Croatia), "the city’s chief physician, Jacob of Padua, advised establishing a place outside the city walls for treatment of ill townspeople and
Artist: Odoardo Fialetti
Unloading a Vessel, From Santi Giovanni e Paolo, Venice, (ca. 1606)
outsiders who came to town seeking a cure."⁵ Ragusa initially imposed a thirty day quarantine, which was later expanded to forty days and, in the winter, fifty days. "During a plague epidemic in 1377, the town council held both foreigners and locals together with their merchandise when they returned from areas considered pestilential. The month-long detention took place on the nearby island of Makan."⁶ The island location was likely chosen for its isolation rather than its convenience in stopping incoming ships from making port. Later buffer island-based lazarettos were used in part because they provided a good place to send arriving ships.

The independent city-state of Venice was the first to establish a digest of rules known as the Laws of Quarantine which were to designed prevent the plague from reaching the city.⁷ Venice appointed three guardians of public health in 1348 - Nicolaus Venerio, Marinus Querino, and Paulas Belegno - who were charged with inspecting ship's crews for signs of the plague as well as some other diseases. Suspect crews, goods and ships were sent to serve out their quarantine on an island in the lagoon.⁸ "By 1374, new ordinances forbade the entrance of suspected ships to the harbor altogether, and required custody of their crews for thirty days (the so-called trentina)."⁹ By 1383, a forty day quarantine was employed at Marseilles.¹⁰ Following a series of plague epidemics around the turn of the fifteenth century, "Venice established by 1403 a hostel on the island of Santa Maria not just for the detention of travelers, but also for the internment of local plague suspects. …where they were now subjected to a longer isolation period, the forty days or quarantine."¹¹

The Italian states established special Magistracies who had legislative, judicial and executive powers in public health matters with their prime focus being the prevention of the plague. The Venetian model was followed by many other port cities. "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."¹²

Following the Fourth Crusade in 1204, Venice gained control of the Ionian Islands, Crete, and some of the Greek coastal cities. Here, they "established a network of trading posts. The islands of Corfu (Greek name Kerkyra), Zante (Zakynthos), Cephalonia, and Leukada were incorporated into the Venetian State in 1386, 1485, 1502, and 1684, respectively, and remained part of it until its demise in 1797."¹³ Venice also used some of these places as buffers to prevent the plague from reaching their city-state. "Archives show that until the end of the Venetian rule on the Ionian Islands, lazzarettos functioned as protective shields for Venice and transferred responsibility of plague control from Venice to peripheral areas. When there was evidence or even suspicion that plague was present on an island, all links to Venice were immediately discontinued for the duration of the threat."¹⁴

¹ Leviticus 13:4-5, King James Bible, 1611; ² Leviticus 13:46, King James Bible, 1611; ³ John Macauley Eager, The early history of quarantine, Yellow Fever Institute Bulletin No12, March, 1903, p. 15; ⁴ Neville M Goodman, International Health Organizations and Their Work, 1971, p. 31 ⁵ Paul S. Sehdev, “The Origin of Quarantine”, Clinical Infectious Diseases, 2002:35, p. 1072; ⁶ Guenter B Risse, Seventeenth-Century Pest Houses or Lazarettos, Jan. 1999, p. 25; ⁷ Proceedings and debates of the Third Annual Meeting of the Quarantine and Sanitary Convention, Baltimore, 1858, p. 259; ⁸ John Keevil, Medicine and Navy, Vol. 1, 1957, p. 84 & Risse, p. 25; ⁹ Risse, p. 26-7; ¹⁰ Keevil, p. 84; ¹¹ Risse, p. 25; Andrew Cliff, Matthew Smallman-Raynor & Peta Steven, Controlling the Geographical Spread of Infectious Disease - Plague in Italy: 1347-1851, 2009,p. 200-1; ¹² Goodman, p. 31; ¹³ Katerina Konstantinidou et al, Venetian Rule and Control of Plague Epidemics on the Ionian Islands during 17th and 18th Centuries, Emerging Infectious Diseases Vol. 15, No. 1, Jan 2009, p. 40; ¹⁴ Konstantinidou et al, p. 42;

The Mediterranean Lazarettos - Medical Men

When plague struck on land, the wealthy often headed out of the city centers to the countryside where the air was better and people were fewer and farther between so as to avoid contracting the plague. Many physicians depended on the wealthier class for their patronage, so they followed them. The primary reason for a land-based doctor to remain behind was mercy or a duty to their profession, not recognition or profit. Sea surgeon John Woodall commented in his treatise on the plague that based upon his

experience in the curing of the diseased of the Plague, that it is generally the ungratefullest recompenced of all other diseases, to the poor and hardie Surgeon: Namely, for that hee, when hee hath recovered his Patient, for the most part is loathed, shunned, and avoided, not only of his Friends and Patients, but for his hazard, cost, and car, is so under-valued, that sometimes, but for the persuming to tell his Patient, after hee hath recovered them, that they had the Plauge, hee hazardeth the future losse of their favours, yea, and sometime, under favour, hath his owne house shut up, to make him amends withal.¹

However, Woodall went on to say, "I neither can nor will refraine in one good way, or another, to be doing good in my Calling, by Medicines or Advice, both in generall and particular, in that or any other disease, so long as God doth give me life and health, with strength thereunto, maugre [in spite of] the ingratitude of the unworthiest sort of men."² He goes on by stating that "the excellencie of the Calling of Surgeons should incite them to zeale where they can, as well without reward as for reward, where povertie is, and need requireth."³ Whether this was meant as an inditement of those medical men who left cities undergoing a plague epidemic rather than remaining behind is not stated.

Medical historian Guenter B. Risse explains that their "activity made plague doctors de facto 'unclean' and a feared source of contagion. Forced to display a cross that revealed their sospetti [suspected] status, the men remained under constant scrutiny throughout the epidemic, unable to mingle with the rest of the population."⁴ Risse also points out that many of the plague doctors "were accused of spreading the plague to further their own interests. They also took bribes for non-reporting of cases, trafficked in herbal remedies, and were accused of stealing valuables."⁵

John Woodall, for all his high-minded call to the nobility of the doctor's profession, didn't exactly write his treatise on the virus without reason. Although he discusses an extensive number of medicines said to be good for treating the plague, providing recipes and recommendations, he also mentions a medicine of his own creation called Aurum vitae in many places without explaining how it is made. Lest the reader miss the virtue of his medicine, he ends his treatise by extolling the virtues of the medicine and providing several certificates testifying to its efficacy.⁶ He indeed worked 'without reward as for reward'.

However, as Risse points out, many of these surgeons "paid with their lives for providing services, while their senior colleagues, on private retainers, left the city for safer and more salubrious [healthy] environments."⁷ In fact, "their willingness of to assume the considerable risks associated with their professional functions earned them the respect of the authorities who often awarded them citizenship, a coveted recompense to launch a private practice after the epidemic ended."⁸

¹ John Woodall, the surgions mate, 1639, p. 318-9; ^2,3 Woodall, p. 319; ^4,5 Guenter B Risse, Seventeenth-Century Pest Houses or Lazarettos, Jan. 1999, p. 34; ⁶ Woodall, p. 367-76; ⁷ Risse, p. 34; ⁸ Risse, p. 34-5

Lazaretto Surgeons

In an effort to treat and examine potential plague victims, lazarettos hired medical staff, "usually young physicians and surgeons with no established practices of their own. Their availability was closely linked to the creation of local medical colleges and surgical guilds in the greater urban centers."¹

¹ Guenter B Risse, Seventeenth-Century Pest Houses or Lazarettos, Jan. 1999, p. 33;

 

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