A brief overview of the Black Death and social distancing: the use (and misuse) of quarantine during pandemics
Pandemics are far from new to humanity and the symptoms of today’s pandemic virus are not unique. Shortness of breath, fever, cough and chest pain link COVID-19 and a very well-known historical pestilence:1 the ‘Black Death’ (or pneumonic plague). A menace (to put it lightly) to humanity in the late Middle Ages,2,3,4 the Black Death was named after the internal bleeding that rendered the skin of victims a deep bruised hue, and was responsible for killing 50% of the population of Europe.
Unlike today’s pandemic, which is caused by a virus, the Black Death was caused by the bacterium Yersinia pestis, transmitted by fleas bites (usually via rats), and was up to 50 times deadlier than COVID-19.5,6
Note: Pneumonic plague is actually still with us, with two cases reported in China as recently as 2019.7
Luckily Y. pestis was effectively eliminated in 1932 with antimicrobial agents known as sulphonamides, and today more modern antibiotics are used.6,8
Although we are now technologically far more advanced, interesting comparisons can be made between the pandemic response measures today and those used in the Middle Ages. The most effective methods today – quarantine and social distancing –were also used and misused in surprisingly similar ways. (Quarantine, a phrase derived from the Italian for 40 days, actually dates back to the time of the Black Death.9)
Effective use
One true story of selfless isolation close to home, which seems to be in direct contrast to today’s ‘anti-maskers’, is the case of Eyam in 1665. Reports indicate the village collectively decided to quarantine themselves within a boundary of stones.10 Even those who were healthy could not escape the disease, but what mattered to them at the time was that they would not spread it. There seem to have been only a few examples of people who broke the quarantine, which lasted for 14 months until the plague burned itself out.10
A little further afield the residents of Milan had a similar response to the plague. Like Eyam, but on a much larger scale, they also cut off access into and out of the city.11,12 As early as the 1370 wave of the plague the city quarantined itself, built plague hospitals and banned pilgrims from entering. Physicians in Milan even began issuing health passports to people. These documents allowed those who had been examined and deemed free of the plague to travel and trade as normal. The Milanese response to the plague was the most successful of the Middle Ages, and was due to unsuperstitious medical practices and the co-ordinated and well-implemented efforts of the ruling nobility of the day.
Effective misuse
Unfortunately, some particularly unpleasant practices were also in effect during the time of the Great Plague. One particularly disturbing example of social distancing was ‘immurement’, the term used for sealing a person into their own home with bricks. Despite its extreme nature, the practice was shown to be highly effective in the containment of plague victims.13
The Spanish in particular were strongly in favour of this practice and it was used alongside the more palatable examples described above.13 When someone was discovered to be suffering from the plague, all the windows and doors in their home would be quickly bricked up. Sadly, this meant that other residents were also sometimes trapped inside – unfortunately this often included members of the household who were not sick.13
Parallels can be drawn to people told to ‘shield’ in the UK today, although the methods of isolation are less permanent; shielders today may be able to empathise more than the average modern human with what it feels like to be bricked inside their home.
Conclusion
To conclude, social distancing remains the most effective method to stop the spread of a pandemic for which there is currently no vaccine or cure. Although we are no longer bricking up the windows of infected houses, interesting parallels can be drawn between now and the pandemics of the past.
By Stephanie James
