*Post written by Mona Meyer, Archives and Special Collections Metadata Librarian.

The threat of COVID-19 wreaked havoc on 2020 and threatens to continue to do so for much of 2021. More staying at home, working or attending school virtually. More cancelled activities and vacations. More staying away from friends and family. More mask wearing. With the arrival of vaccines, the end may be in sight, but it’s still a long way off. That said, it can be useful to gain some perspective by taking a brief look at other times in history when humankind has endured pandemics and quarantines. At the end there’s a bit of a twist, a different kind of quarantine.

Let’s start with the word, “quarantine.” Today, if you’ve been exposed to or have contracted the coronavirus, you are told to stay away from others, to quarantine yourself, for 14 days. But did you know that the word itself comes from the Latin quaranta, meaning 40? Makes 14 days seem easy, doesn’t it? In the middle 1300s, the plague began to sweep across Europe to great cost—it is estimated that 1/3 of the population died. With virtually no medical knowledge on which to draw, desperate measures were taken. “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. A similar strategy was used in the busy Mediterranean sea-port of Ragusa (modern Dubrovnik, Croatia). After a visitation of the black death, the city’s chief physician, Jacob of Padua, advised establishing a place outside the city walls for treatment of ill townspeople and outsiders who came to town seeking a cure The impetus for these recommendations was an early contagion theory, which promoted separation of healthy persons from those who were sick.” This was only partially successful, and in 1377 the city of Ragusa enacted strict laws enforcing what was at first a trentino, or 30 day isolation. No one could enter Ragusa without first quarantining for 30 days, and any arriving ship had to sit at anchor that long before landing. Anyone venturing into the isolation area (which was forbidden) was forced to stay for 30 days. Only those caring for the sick were permitted to bring food to anyone isolated. Over the years other municipalities enacted similar laws, although the isolation period grew from a trentino to a quarantino, the 40 day period from which today’s word quarantine derives. Why the change? Besides the obvious reason that the 30 day period didn’t produce sufficient results, there are theories that link this to the importance of the number 40 in the Bible—it rained 40 days and nights during the Great Flood, Moses spent 40 days on Mt. Sinai, the 40 days of Lent, and/or Jesus’ 40 days in the wilderness. No matter the explanation, today we speak of quarantine even when we don’t mean 40 days.

While this official term for isolation wasn’t established until the 12^th century, the practice of keeping those who are sick apart from others is ancient. Those suffering from leprosy are a prime example—the Bible mentions it 55 times in the Old Testament and 13 times in the New Testament. Lepers were shunned; the book of Leviticus calls them unclean. (The focus in the New Testament was different, with stories of Jesus touching and healing lepers.) Shunning the leper by separating him/her from society isn’t just a Biblical phenomenon. In 1866 a portion of the Hawaiian island of Molokai was designated a leper colony, and shiploads of new patients arrived several times a year, more than 8000 in all. Sufferers were taken from their families and sent to Molokai, expecting to die there. The facility didn’t close until 1969. The National Leprosarium of the United States was established in 1921 in Carville, LA, although lepers were sent there as early as 1894, the last in 1999. Some 4,500 patients passed through Carville. A very small number were housed and treated on Penikese Island, off the coast of Massachusetts, from 1905-1921.

Over the centuries the world has been swept with devastating pandemics. Below are just a few examples.

What is thought to be typhoid fever swept Greece in 430 B.C., killing 2/3 of the population.

The Black Death or bubonic plague ravaged Europe, beginning as early as 1347. “England and France were so incapacitated by the plague that the countries called a truce to their war. The British feudal system collapsed when the plague changed economic circumstances and demographics. Ravaging populations in Greenland, Vikings lost the strength to wage battle against native populations, and their exploration of North America halted.” In 1665 it came again to London, killing 20% of the population. In 1855 it moved across China, India, and Hong Kong, taking 15 million lives.

The arrival of the Spanish and other Europeans in the New World, bringing with them disease, decimated the native populations. The native population of Hispaniola dropped from 60,000 to less than 500 after Columbus arrived. Smallpox destroyed the Aztec empire in 1520.

In 1817, “the first of seven cholera pandemics over the next 150 years, [the first] wave of the small intestine infection originated in Russia, where one million people died. Spreading through feces-infected water and food, the bacterium was passed along to British soldiers who brought it to India where millions more died. The reach of the British Empire and its navy spread cholera to Spain, Africa, Indonesia, China, Japan, Italy, Germany and America, where it killed 150,000 people. A vaccine was created in 1885, but pandemics continued.”

In 1918, the Spanish flu killed 50 million people across the globe, but it did not originate in Spain. In 1918, the Axis and Allied powers were waging WWI and refused to acknowledge the flu. Spain was a neutral country and thus not subject to such news blackouts, so the first report of the pandemic came from Madrid.

Yellow fever, SARS, Ebola, HIV/AIDS, and now COVID-19 are just a few of the other diseases that precipitate the need for isolation and/or quarantine.

The efficacy of prevention measures is dependent on a solid knowledge of the cause of the disease in question and how it is spread. Louis Pasteur published his findings about the role of bacteria in anthrax and helped establish the germ theory in 1861. In 1876 a German physician by the name of Robert Koch was able to replicate that, and in 1882 identified the bacteria causing tuberculosis. These findings were incredible and should have caused a huge drop in the number of cases of these diseases…except for the fact that medical science dragged its feet, not accepting germ theory until early in the 20^th century. “Koch’s contemporaries were trained to believe that, “most diseases were caused by miasmas, undisciplined lifestyles, and anything other than tiny living organisms.”” The other important factor is understanding the incubation period. The moment the disease-causing mechanism enters the body, the host is infected. The host may not show symptoms, and any symptoms (fever, for instance) may be related to the immune response and not the disease itself. Consider the case of Typhoid Mary who, while harboring the bacteria causing typhoid fever and unknowingly infecting others, was herself completely asymptomatic and in good health.

“Isolation is established when those people who belong in the red circle are restricted in their movements.

Quarantine occurs when those people who belong in the yellow circle have their movement restricted as well.

One unique quarantine began on July 24, 1969. That marked the day the Apollo 11 astronauts returned to Earth, and NASA wanted to make sure that they didn’t bring back a lunar plague. Here’s how this worked: as soon as they splashed down, astronauts Edwin E. Aldrin Jr. (aka Buzz), Neil A. Armstrong, and Michael Collins had to don special biological isolation garments while still inside the capsule. Then the hatch was opened, and they were taken by helicopter, with as little contact as possible, to the USS Hornet, the awaiting recovery vessel. After disembarking from the helicopter onto the ship, they headed straight into a Mobile Quarantine Facility (MQF) already aboard the ship. It was a converted Airstream trailer “which was essentially a highly modified, wheelless, 35-foot vacation trailer equipped with elaborate air ventilation and filtration systems. It contained sleeping quarters, a kitchen, and a bathroom. The astronauts remained in the MQF for the duration of their journey to Houston, which was a long voyage. From the USS Hornet, the MQF was transported to the Pearl Harbor Naval Base in Hawaii, and from there to nearby Hickam Air Force Base. At Hickam, the MQF was loaded into the cargo hold of a C-141 aircraft and flown to Ellington Air Force Base. With the astronauts still on board, it was then transported to the NASA LRL where there were more spacious quarantine facilities.”

The LRL was the Lunar Receiving Laboratory, a large facility at NASA Johnson Space Center in Houston.

“The LRL consisted of four major functional areas – the Crew Reception Area (CRA), the Sample Operations Area, the Radiation Counting Laboratory, and the Administrative and Support Area. The CRA and the Sample Operations Area were inside the biological barrier to prevent any accidental contamination of the Earth with any possible, however unlikely, lunar microorganisms. A complex vacuum system ensured that air could not escape from the facility and also that the terrestrial atmosphere would not contaminate any of the pristine lunar samples. The CRA included dormitories for not only the three returning astronauts but also for the staff who were in quarantine with the crew. The Apollo Command Module was kept in quarantine in its own room within the CRA. Medical facilities, a small gym, a kitchen and dining area, and a glass-walled room for holding debriefings and press conferences rounded out the CRA. The Sample Operations Area included a gas analysis laboratory, a vacuum laboratory, and physical and biological sciences test laboratories. In these laboratories, many including vacuum gloveboxes, lunar samples were put through a variety of analyses to test their structure and composition as well as their effects on biological systems. The Radiation Counting Lab housed a state-of-the-art gamma-ray spectrometry laboratory constructed of low-background radiation material and built 50 feet underground to minimize exposure to background radiation. The Administration and Support Area included offices and conference rooms for managers, technicians and secretaries supporting the LRL activities.” Quarantine lasted 21 days. There’s an amusing and informative video here about the whole lunar plague quarantine thing….enjoy!

Bird-beaked plague masks. The miasma theory of contagion. 40 days and 40 nights. Leper colonies. Typhoid Mary. Possible lunar plague. All are part of the history of quarantine/social distancing/isolation that we’re dealing with now. Here’s to a better 2021!

Resources Consulted

“Apollo mission quarantine procedures.” Spacecenter.org blog, March 24, 2020.

Drews, Kelly. “A Brief History of Quarantine.” The Virginia Tech Undergraduate Historical Review: 2, May 1, 2013.

“50 Years Ago, On the Way to the Moon…” NASA.org, October 31, 2018.

Frost, Natasha. “Quarantined for Life: The Tragic History of US Leprosy Colonies.” History.com, March 31, 2020.

History of Quarantine. NOVA (PBS science program)

Kliabonoff, Eleanor. A History Of Quarantines, From Bubonic Plague To Typhoid Mary. npr.org, January 26, 2020.

“Pandemics That Changed History.” History.com editors, April 1, 2020.

Roos, Dave. How U.S. Cities Tried to Halt the Spread of the 1918 Spanish Flu. History.com, March 27, 2020.

Senthilingam, Meera. “Taken from their families: The dark history of Hawaii’s leprosy colony.” CNN.com, September 9, 2015.

Sehdev, Paul S. “The Origin of Quarantine.” Clinical Infectious Diseases 2002(35), November 1, 2002, p. 1071-1072.

Tognotti, Eugenia. “Lessons from the history of quarantine, from plague to influenza A.” Emerging Infectious Diseases, v. 19,no.2 (2013): p. 254-9.