ž © by author DUBROVNIK QUARANTINE ESCMID-What canOnline we learn Lecture from the Library history ESCMID Mobility and Infection, 16-17 October 2014 Ljiljana Betica Radić Presentation outline • Introduction • Public health measures in old Dubrovnik ©• byDubrovnik author quarantine ESCMID Online• Major Lecture ethical Library issues Presentation outline • Introduction • Public health measures in old Dubrovnik ©• Dubrovnikby author quarantine ESCMID Online• Major Lecture ethical Library issues • Each culture has its • We live in the age of predominant disease cancer, cardiovascular (Cipola, Grmek) diseases and psychotic disorders ... , but also in • The early Middle Ages the age of fear of struggled with leprosy bioterrorism and and later, plague emerging and prevailed © by authorreemerging infections diseases •ESCMID The Industrial RevolutionOnline Lecture Library was the age of tuberculosis © by author ESCMID Online Lecture Library 30 © 40by author ESCMID Online21 Lecture Library © by author ESCMID Online Lecture Library 20.07.1969 The crew of Apollo 11 in quarantine 21days after returning to Earth, visited by Richard Nixon • This practice continued for two more Apollo missions, 12 and 14, • before the Moon was proven to be barren of life and the quarantine process dropped © by author ESCMID Online Lecture Library Federal isolation and quarantine are authorized for these communicable diseases • Cholera • Yellow fever • Diphtheria • Viral hemorrhagic • Infectious fevers tuberculosis • Severe acute • Plague respiratory • Smallpox © by authorsyndromes • Flu that can cause a ESCMID Online Lecturepandemic Library Twelve Diseases That Changed Our World Irwin Sherman, professor emeritus of biology describes in his book smallpox, tuberculosis, syphilis, AIDS, influenza, plague, cholera, malaria, yellow fever, two noninfectious diseases (hemophilia and ©porphyria by author), and the plant disease behind the Irish Potato Famine— haveESCMID altered historyOnline Lecture Library by Irwin Sherman It's often taught that the course of history hinges upon great battles Time line • The practice of quarantine—the separation of the diseased from the healthy—has been around a long time • As early as the writing of the Old Testament, rules existed for© isolating by author lepers ESCMID Online Lecture Library • It wasn't until the Black Death of the 14th • In the mid-20th century, the advent of antibiotics and routine vaccinations made large-scale quarantines a thing of the past but • Today bioterrorism© by and author newly emergent diseases threaten to restore the age-old ESCMIDcustom Online Lecture Library © by author ESCMID Online Lecture Library After the first outbreaks of plague in 1348, governments in some cities legislated measures according to the classical theories measures according to the classical theories • They tried to clean the • They ordered the putrefying air by setting sprinkling of houses fires with sweet-smelling with vinegar and rose herbs odour water and enforced more rigorous measures of cleanliness (removal of © by authordecaying animals and of human wastes) ESCMID Online Lecture Library Dr. Zlata Blažina Tomić, McGill University, Toronto,1981 and 2007 • These measures helped in improving the general sanitary conditions, in the cities, but they did little for the prevention of plague epidemics • Other governments tried to isolate the sick from the healthy© on by the author basis of contagion ESCMID Online Lecture Library Dr. Zlata Blažina Tomić, McGill University, Toronto,1981 and 2007 Presentation outline • Introduction • Public health measures in old Dubrovnik ©• Dubrovnikby author quarantine ESCMID Online• Major Lecture ethical Library issues • The citizens of Dubrovnik were aware of the significance of the latest public health and hygienic achievements for the development of their city • Dubrovnik has,© everby author since its foundation, been connected with ESCMIDmedicine Online Lecture Library Slobodan Lang & Ana Borovečki studied public health measures in old Dubrovnik and published A GUIDE TO THE HISTORY OF MEDICINE IN OLD DUBROVNIK, 2007 © by author ESCMID Online Lecture Library The beginnings of medicine in Dubrovnik Rector’s palace- on the capital there is a figure of Aesculapius who has a long beard and a typical hat. He welcomes the patients in his alchemy laboratory. His servant (a citizen) leads © by authorhis patient (a peasant) who has in his hands a chicken ESCMID Online Lecture(the Library traditional fee of physicians) to Aesculapius. • The traditional medicine was mainly based on herbal medicine • The help of the saints was also often sought in the case of an illness. The votive tradition and the cult of St. Blaise, a medicine man himself, are just a few examples of this© by author religious medical tradition –ESCMID The church of Saint Blaise Online is dedicated toLecture Library the patron of Dubrovnik Saint Blaise. His blessing is considered to have protective powers against the illness of the throat basic principles 1. Freedom 2. Patriotism 3. Justice © by author ESCMID Online Lecture Library The respect for human dignity and ethical awareness were always of a high standard in old Dubrovnik © by author ESCMID Online Lecture Library Lovrijenac fortress Old inscriptions on fortresses and palaces 1. FREEDOM © by author • ESCMIDOver the entrance Online to Lovrijenac Lecture fortress Libraryan ancient inscription reads as follows: NON BENE PRO TOTO LIBERTAS VENDITUR AURO. In translation: Freedom is not sold for all the gold in the world © by author ESCMID Online Lecture Library RECTOR’S PALACE 2. PATRIOTISM © by author ESCMID Online Lecture Library Inscription at the entrace to a Small Council - RECTOR’S PALACE OBLITI PRIVATORUM PUBLICA CURATE (Forgetting your private business, concern yourselves with public affairs) © by author ESCMID Online Lecture Library SPONZA PALACE (Dubrovnik’s archive) 3. JUSTICE The fact that the city measures were true is captured on© the by inscription author on the arch: FALLERE NOSTRA VETANT; ET FALLI PONDERA: MEQUE PONDERO ESCMID CVM MERCES: Online PONDERAT Lecture IPSE Library DEVS (Our weights do not permit cheating or being cheated. When I measure goods the Lord measures with me) © by author ESCMID Online Lecture Library Dubrovnik’s archive is considered to be one of the best-preserved archives for the research of all aspects of life in a city including the research of its public health conditions © by author ESCMID Online Lecture Library The statute of the city of Dubrovnik from 1272 is one of the oldest Croatian legal documents Although its main significance is connected with the Croatian legal history one can find a number of regulations © by authorconcerning medicine and the quality of life ESCMID Online Lectureof the Library population of Dubrovnik What we know from these documents • In 1336 people were forbidden to keep animals in the city • In 1407 a regulation was introduced that all the streets in Dubrovnik should be paved and in 1415 the first city street- sweepers were introduced • From 1407 to 1436 a sewage system was introduced © by author • In 1436 a 20km water system supplyESCMID was constructed Online Lecture Library The Republic of Dubrovnik was very inventive regarding laws and institutions that were developed very early • was In 1301 Medical service introduced • In 1317 The first pharmacy (still working) was opened • In 1347 The Asylum for Elderly people © by author • In 1418 Slave trading was abolished ESCMID Online Lecture Library • In 1432 The orphanage was opened Presentation outline • Introduction • Public health measures in old Dubrovnik ©• Dubrovnikby author quarantine ESCMID Online• Major Lecture ethical Library issues © by author • As a city open to travellers, Dubrovnik faced continuous exposure to epidemics of contagious diseases ESCMID Online Lecture Library • The leper house in Dubrovnik, mentioned in the city’s statute of 1272, was provided outside the walls for the sick © by author ESCMID Online Lecture Library • Decision of suspension of trade with other regions would have been fatal for the economy of the city • The most important goal was to prevent the © by author spread of the plague in Dubrovnik without impedingESCMID the free Online trade Lecture Library vital for the city (Belitza, Ferencic, Blazina Tomic) High mortality • Ragusans recognized empiricaly the nature of plague in its pneumonic and bubonic forms, and were above all, aware of its extreme contagiousness • All the physicians and surgeons present in Dubrovnik in 1348 died during the epidemic • They seemed to know that medical doctrine was useless © by author ESCMID Online Lecture Library (Belitza, Ferencic, Blazina Tomic) • On July 27 in the year 1377, the Great Council, with 47 members present, has decided by 34 votes that those who, come from plague-infested' areas', will not be admitted to Ragusa (Dubrovnik) or its surroundings unless they previously spend a month on the island of Mrkan or in Cavtat for the purpose of disinfection © by author ESCMID Online Lecture Library Dr. Zlata Blažina Tomić, McGill University, Toronto,1981 and 2007 State Archives in Dubrovnik, (Sponza Palace) The text of this decree can be seen in Liber viridis (c.49 fol. 78) under the title: “Veniens de locis pestiferis non intret Ragusinum vel districtum” (“It is forbidden to newcomers from the infested regions© toby enter author Dubrovnik and its surroundings”) ESCMID Online Lecture Library (QUARANTINE: Marseille 1383, Venetia 1403, Pisa 1464, Genova 1467, Mallorca 1471) © by author