The Story of the plague in the Maritime Republic of Genoa (Italy) (1656-1657): An innovative public health system and an efficacious method of territorial health organization.

Introduction: With the recent COVID-19 pandemic, the terms quarantine, contagion and infection have again become part of our everyday speech, prompting historians to reflect on the settings in which they were originally used and to make comparisons with the present time. How did people cope with epidemics in the past? What measures were taken? Objectives: Here, we analyse the institutional response of the Republic of Genoa to a calamity that shook the city - the plague of 1656-1657. In doing so, we focus particularly on the public health measures implemented, as recorded also in unpublished and archival documents. Discussion: In order to tighten control over the population, Genoa was divided into 20 zones, each of which was placed under the authority of a Commissioner endowed with criminal jurisdiction. The Commissioners' duties concerned the spheres of public health, public order and those tasks which today we would assign to "civil protection". Through the official documentation and the trial records kept by the Chancellor of one of these zones, we can shed light on the Commissioners' everyday activities and assess the impact of the public health measures on the population. Conclusions: The 17th century plague in Genoa provides us with an important testimony of a well-organised and structured public health policy - an institutional response involving the adoption of efficacious measures of safety and prevention in the field of hygiene and public health. From the historical-social, normative and public health perspectives, this meaningful experience highlights the organisation of a large port city, which was at the time a flourishing commercial and financial hub.

Quarantine as a tool of epidemic fight.

Until the 19th century, the factor causing epidemics was not known, and the escape from a place where it occurred as well as isolation of patients was considered to be the only effective way to avoid illness and death. Quarantine in a sense similar to modern times was used in 1377 in Ragusa, today's Dubrovnik, during the plague epidemic. It was the first administratively imposed procedure in the world's history. It was later used in Venice and other rich port cities in the Mediterranean. On the territory of today's Poland, quarantine measures were used by the so-called Mayor of the Air - LukaszDrewno in 1623 during the plague epidemic in Warsaw. The quarantine left its mark on all areas of human activity. It affected all humanity in a way that is underestimated today. Throughout history, it has been described and presented visually. It is omnipresent in the world literature, art and philosophy. However, the isolation and closure of cities, limiting trade, had an impact on the economic balance, and the dilemma between the choice of inhabitants' health and the quality of existence, i.e. their wealth, has been the subject of discussions since the Middle Ages. Since the end of the 19th century, quarantine has lost its practical meaning. The discovery of bacteria and a huge development of medical and social sciences allowed limiting its range. In the 20th century isolation and quarantine no longer had a global range, because the ability to identify factors causing the epidemic, knowledge about the incubation period, carrier, infectiousness, enabled the rational determination of its duration and territorial range. The modern SARS COV 2 pandemic has resulted in a global quarantine on a scale unprecedented for at least three hundred years. The aim of this paper is to present the history of quarantine from its beginning to the present day, including its usefulness as an epidemiological tool.

Learning from the past in the COVID-19 era: rediscovery of quarantine, previous pandemics, origin of hospitals and national healthcare systems, and ethics in medicine.

After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece-the cradle of medicine-to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well.

COVID-19 and the ethics of quarantine: a lesson from the Eyam plague.

The recent outbreak of the SARS-CoV-2 coronavirus is posing many different challenges to local communities, directly affected by the pandemic, and to the global community, trying to find how to respond to this threat in a larger scale. The history of the Eyam Plague, read in light of Ross Upshur's Four Principles for the Justification of Public Health Intervention, and of the Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, could provide useful guidance in navigating the complex ethical issues that arise when quarantine measures need to be put in place.