Maybe, Just Maybe . . .

Something Positive Will Come Out Of All This . . .

s we all struggle to get back to “normal,” sometimes it is important to look back at history to see how impactful episodes, like pandemics, have actually fostered positive change in the way we live.

The very first world-wide health crisis occurred in the 1300’s – the Bubonic Plague. Nearly 700 years ago, overwhelmed physicians and health officials in medieval Italy had no notion of viruses or bacteria, but they understood enough about this illness to implement some of the world’s first anti-contagion measures.

Starting in 1348, soon after the plague arrived in cities like Venice and Milan, city officials put emergency public health measures in place that foreshad-owed today’s best practices of social distancing and disinfecting surfaces.

In fact, the practice of quarantine, as we know it, began during the 14th centu-ry to protect coastal cities from plague epidemics. It was first introduced in the Adriatic port city of Ragusa, which is Dubrovnik today. Ships and trade caravans arriving from plague-infested areas could not actually come into Ra-gusa until they had spent a month on a rocky island called Mrkan, located south of the city. Some historians consider this practice one of the highest achievements of medieval medicine.

The Italian port city of Venice took this practice a step further. Venice, proba-bly the predominant trading port in the world at that time, now required ships from infected ports to sit at anchor for 40 days before landing. The Venetians named this practice quaran-tine, which was derived from the Italian words quaranta giorni, which mean 40 days.

Why 40 days? Health offi-cials probably picked a 40-day quarantine because the number had great symbolic and religious significance to medieval Christians. When God flooded the Earth, it rained for 40 days and 40 nights, and Jesus fasted in the wilderness for 40 days. Even women, after childbirth were ex-pected to rest for 40 days.

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Summer 2020

A

“Can Some-

thing Positive

Really Come

Out of a World-

Wide

Pandemic?”

But, the city of Ragusa took additional steps, revolutionary at the time, to protect its citizenry from this horrible illness. They were the first city to set up a temporary plague hospital on another island called Mljet. Venice soon followed suit with their own plague hospital, built on an island near the city. This new type of state-funded treatment facility would soon become known throughout Europe as a lazaretto.

The lazaretto served two functions, as a medical treatment center and a quarantine facility. It was a way to compassionately care for both new arrivals and local citizens who fell sick with the plague while keeping them isolated from the healthy. At a lazaretto, plague-infected patients would receive fresh food, clean bedding, and other health-promoting treatments, all paid for by the state.

Now, despite all these important changes, the plague did not go away because there was no cure yet. It con-tinued to resurface in Europe for centuries, and came back with a vengeance in Italy in the 17th century, killing more than 45,000 Venetians and wiping out half the population of cities like Parma and Verona.

But there was one city that managed to avoid even a single death from the contagion - the northern Italian town of Ferrara. How? Researchers at the University of Ferrara uncovered a Renaissance-era approach to “integrated disease management.” They credit Ferrara’s remarkable success to a combination of strict border surveillance, aggressive public sanitation and rigorous personal hygiene regimens that tapped the natural anti-microbial properties of herbs, oils and even scorpion and snake venom. Sound familiar? Well, maybe except for the snake venom!

Ferrara was ahead of its time in a number of other areas – it had its first paved road in 1375 and a working mu-nicipal sewer system in 1425. Plus, it is a walled-city, giving local authorities the ability to establish effective quarantines periodically. In the 17th century, the highest threat level meant closing all but two of the city gates

and posting permanent surveillance teams composed of wealthy noble-men, city officials, physicians and apothecaries. Anyone arriving at the city gates needed to carry identification papers to ensure they had arrived from a plague-free zone, and then would be screened for any signs of disease.

City streets were swept of garbage and cleared of “filthy” animals like dogs, cats and chickens . . . and lime powder, universally believed to be a disin-fectant, was spread liberally on any surface that may have come in contact with an infected person.

Inside homes, residents tried a host of measures to disinfect objects and surfaces. Any damaged or cracked furniture was taken out and burned. Valuable objects and money were heated close to a fire and perfumes were sprayed throughout the house for 15 days. Clothing and other tex-tiles were hung out in the sun, beaten and doused with perfumes.

Plus, Ferrara extended the quarantine further by building and maintaining its Iazaretto outside the city limits, effectively isolating any infected citizens.

And, rigid enforcement of all these rules resulted in one city avoiding any fatalities during this horrific period of the “Black Death.” And, you can see how the response to our current health scare was born in this period four centuries ago.

Fast-forward to another epidemic that really hit the United States hard in the mid-19th century. Cholera tore through New York City in the summer of 1832. It had swept from its origins in Asia and then made its way across Europe before arriving at New York’s shores. It only took a matter of weeks for cholera to claim the lives of more than 3,500 of the city’s 250,000 citizens. That would be equivalent to around 120,000 deaths today.

Nineteenth-century cities were crowded, filthy places that provided the perfect breeding ground for diseases such as cholera. While garbage, animal manure and human waste flowed freely into drinking water sources, it was the pungent cocktail of odors they produced that many medical professionals blamed for spreading dis-ease.

Public health officials adhered to an idea dating back to the Middle Ages that infectious diseases were primarily caused by noxious vapors known as “miasma” emitted from rotting organic matter. Medical professionals advocat-ed for better ventilation, drainage and sanitary practices to rid cities of foul-smelling, malevolent air. City leaders in New York, for instance, responded to cholera outbreaks by banishing 20,000 pigs from the heart of the city and constructing a 41-mile aqueduct system that delivered clean drinking water from north of the city.

But, perhaps the most lasting consequence of attempting to treat the cholera pandemic was the introduction of urban design elements, such as wide boulevards and parks, that transformed New York and other major cities into the iconic metropolises we know today.

Another miasma theory devotee, landscape architect Frederick Law Olmsted, advocated for the healing powers of parks, which he be-lieved could act like urban lungs as “outlets for foul air and inlets for pure air.”

His writing often references the importance of large open spaces to allow people to access fresh air and sunlight, and discusses how air could be “disinfected” by sun and foliage. New York City hired Olmsted to start planning and designing Central Park in the immedi-ate aftermath of New York’s second cholera outbreak. Thanks to the success of that project, Olmsted, whose first child had died of cholera, went on to design more than 100 public parks and recrea-tion grounds all over the country, including our very own Piedmont Park in Atlanta, as cities everywhere began to embrace the concept of a more healthy urban lifestyle.

And it wasn’t just here in the U.S.

As cholera roared through London in 1854 and took the lives of approximately 10,000 of its residents, British physi-cian John Snow mapped instances of the disease in one neighborhood and found a connection not to contaminat-ed air, but to a public well contaminated by leaking sewage. In the summer of 1858 it caused the “Great Stink,” an

odor so repugnant it forced the closure of the Houses of Par-liament and the construction of a modern sewer system that transported the city’s waste far enough away from London that the river’s tides took it out to sea. In addition, the mud-dy shorelines of the Thames were narrowed and replaced with embankments with riverside roads and gardens.

Across the English Channel, Emperor Napoleon III came to power in France in 1848 amid a cholera outbreak that took the lives of approximately 19,000 Parisians. An admirer of the parks and garden squares of London, he sought to re-make Paris in the wake of the pandemic.

Under the direction of Baron Georges-Eugène Haussmann, French authorities tore down 12,000 buildings, built tree-lined boulevards and parks, erected fountains and installed an elaborate sewage system that transformed Par-is into the modern-day “City of Light.”

So, out of two horrible epidemics in the past came an appreciation and commitment to cleanliness, acute medical care, more efficient public works projects and an incredible aesthetic change to urban landscapes everywhere that we can still see and enjoy today. Let’s just hope that the lasting legacy of our current pandemic will ultimately pro-duce something that will actually improve the quality of the world and the way of life we leave our children and grandchildren.

Ray

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