A History Of Quarantine, From The Black Death To Typhoid Mary
MELISSA BLOCK, HOST:
The word quarantine comes from the Italian derived from quaranta or 40. In the context of disease, it goes back to the Middle Ages. It refers to the period of 40 days that a ship from a country stricken with bubonic plague would be prevented from entering Italian ports. But the practice of quarantining or isolating diseased people goes back way further than that. Dr. Howard Markel has written several books about epidemics and quarantine. He directs the Center for the History of Medicine at the University of Michigan. Dr. Markel, welcome to the program.
HOWARD MARKEL: Thank you for having me.
BLOCK: And first, why don't you help clarify for us the distinction between quarantine and isolation.
MARKEL: Well, that's a good question and not many people understand that isolation refers to a patient who actually has the infectious disease in question. Quarantine refers to those who either have had direct contact with the highly contagious disease or are suspected of having contact with somebody with an infectious disease.
BLOCK: But quarantine is pretty much come to be used universally for both.
MARKEL: Yes, it has. And a little bit too imprecisely for this historian. (Laugher)
BLOCK: Well, if you are trying to find the earliest historical examples of quarantine for disease, what would you find?
MARKEL: Well, you know, people have always avoided other people with infectious diseases - with runny noses or coughing and sneezing or other disgusting symptoms. But as you stated in your introduction, the word quarantine is really - comes around in response to the black plague, and it was ports like Venice - but there's also cities like Padua - that were responding to people who are coming in carrying the bubonic plague.
BLOCK: Dr. Markel, what about the influenza pandemic of 1918? Huge numbers of cases and huge numbers of deaths - was quarantine used then?
MARKEL: Well, quarantine and isolation were very much alive back then. And when you think or hear the popular stories about the flu of 1918, you hear this tale that flu came. And it killed everybody in its path, and that's not quite true. Different cities in the United States and elsewhere had different experiences. And we found that those cities that acted very early and used quarantine and isolation - buttressed by other layers such as school closure, public gathering bans - did them for a long period of time because you're not curing the flu. You're merely holding it at bay. And those cities that did those layered approaches and did them well had a far better experience with less cases and less deaths than those that did not.
BLOCK: Well Dr. Markel, as somebody who has studied the history of epidemics and of quarantine and isolation, when you look at what's going on now in this country and the government response to it, does it make sense you?
MARKEL: Well, it doesn't make complete sense to me, and I feel as if I'm living my books all over again. But when Governor Christie ordered the quarantine of Ms. Hickox the other day, that did not seem to make sense to me in terms of how the disease is spread and what her symptom pattern - well she had no symptoms - were. And I think it's really important when you set such a huge order and when you use a bazooka, when a BB gun would do, you really have to think about that order because if the order does not halt the spread of infectious disease, and instead it causes fear or panic or even distrust of the leadership that is running the response to an epidemic, you need to think very seriously about that order. I think the uniform guidelines that the CDC has delivered about how to handle healthcare workers from Ebola stricken nations and other people are common sense answers and good solutions to a uniform means of handling this issue.
BLOCK: Dr. Markel, thanks very much.
MARKEL: Thank you.
BLOCK: That's Dr. Howard Markel. He directs the Center for the History of Medicine at the University of Michigan.