The Origin of Quarantine
Sehdev, Paul S. (Department of Medicine, Division of Geographic Medicine, University of Maryland School of Medicine, Baltimore )
Clinical Infectious Diseases, Volume 35, Issue 9 (2002)
In modern times, the yellow flag depicted in this cartoon (figure 1) was used to announce that a quarantine against yellow fever was in effect. Although the use of flags to signal a quarantine is a recent phenomenon, societies have, since ancient times, used strategies to isolate persons with disease from unaffected persons. Some of the earliest references to these strategies are found in the books of the Old Testament. In Leviticus, chapter 13, it is stated that anyone with leprosy remains unclean as long as they have the disease and that they must live outside the camp away from others [1, Lev. 13.46]. Numbers, chapter 5, prescribes a duty to expel from camp everyone with a dreaded skin disease or bodily discharge [1, Num. 5.2]. However, nowhere in these early accounts does the term “quarantine” appear. How, then, did the term become part of the modern lexicon? The answer to this question can be found in the history of the black death in Europe.
Beginning in middle of the 14th century, repeated waves of plague swept across Europe. After arriving in southern Europe in 1347, plague spread rapidly, reaching England, Germany, and Russia by 1350. During this time, it is estimated that one-third of Europe’s population died. The profound impact of the epidemic led to the institution of extreme infection-control measures. For example, in 1374, Viscount Bernabo of Reggio, Italy, declared that every person with plague be taken out of the city into the fields, there to die or to recover.