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.

Devastating epidemics in recent ages Greek populations

In the recent Greek ages the most devastating epidemics were plague, smallpox, leprosy and cholera. In 1816 plague struck the Ionian and Aegean Islands, mainland Greece, Constantinople and Smyrna. The Venetians ruling the Ionian Islands effectively combated plague in contrast to the Ottomans ruling all other regions. In 1922, plague appeared in Patras refugees who were expelled by the Turks from Smyrna and Asia Minor. Inoculation against smallpox was first performed in Thessaly by the Greek women, and the Greek doctors Emmanouel Timonis (1713, Oxford) and Jakovos Pylarinos (1715, Venice) made relevant scientific publications. The first leper colony opened in Chios Island. In Crete, Spinalonga was transformed into a leper island, which following the Independence War against Turkish occupation and the unification of Crete with Greece in 1913, was classified as an International Leper Hospital. Cholera struck Greece in 1853-1854 brought by the French troops during the Crimean War, and again during the Balkan Wars (1912-13) when the Bulgarian troops brought cholera to northern Greece. Due to successive wars, medical assistance was not always available, so desperate people turned many times to religion through processions in honor of local saints, for their salvation in epidemics.

[History of human epidemic and endemic diseases in the southwest Indian Ocean]. / Histoire des épidémies et des endémoépidémies humaines dans le sud-ouest de l'océan Indien.

Smallpox has been known in the Mascarene Islands since 1729, and in 1898, the vaccinogenic and anti-rabies Institute of Tananarive, the future Pasteur Institute of Madagascar, was created to combat it. Cholera first arrived in the Mascarenes in 1819, but did not affect the Comoros Islands and Madagascar until the current pandemic. Bubonic plague has beset the ports of Madagascar and the Mascarenes since 1898. Girard and Robic developed the anti-plague vaccine in 1931 at the Pasteur Institute of Madagascar. The Mascarenes lost their reputation as Eden when malaria arrived in 1841, and this disease remains prominent in Madagascar and Comoros. Leprosy has been known in La Réunion since 1726 and is still very present in Mayotte, Anjouan, and Madagascar. Leptospirosis is a public health problem, except in Madagascar and the Comoros. Dengue, chikungunya, and Rift Valley fever are also present. HIV/AIDS is not a major concern, except in Mauritius, where it was spread by injection drug use, in the Seychelles and in Madagascar's largest cities. Madagascar is the principal site worldwide of chromoblastomycosis, first described there in 1914.

El cólera en el Buenos Aires del siglo XIX / The cholera in Buenos Aires of the XIX century

Presenta una explicación de las epidemias de cólera en el siglo XIX, Buenos Aires. Tal como ocurrió con la lepra –confundidacon otras afecciones con manifestaciones en la piel–, el cólera debe haber dado motivo a diagnósticos erróneos, sospechado anteotras enfermedades gastrointestinales con diarreas y vómitos, lo que dificulta señalar con exactitud su verdadero comienzo como epidemia que diezmaba a las poblaciones. Fue conocida como cólera simple, cólera nostras, cólera europeo, cólera infantil y cólera morbo. Sendrail no hace mucho hincapié por dilucidar esa confusión: “Se llama disentería a todas las afecciones caracterizadas por exoneraciones sangrantes y flemonosas, inevitables y múltiples. Se trata de un grupo confuso que reúne diversas enfermedades todavía no individualizadas; es muy probable que muchas de ellas sean disenterías bacilares. En 1626, Senne afirma que son contagiosas. Frecuentemente asociadas al tifus, la disentería se observa sobretodo en los ejércitos en lucha”.

Memórias da cólera no Pará (1855 e 1991): tragédias se repetem? / Memories of cholera in Pará (1855 and 1991): tragedies repeat them selves?

Na epidemia de cólera no Pará, em 1991, o número de vítimas foi elevado, e embora os enfermos se recuperassem rapidamente, relutavam em deixar o hospital. As condições de vida no século XIX eram, guardadas as proporções, semelhantes às enfrentadas pelos coléricos agora atendidos no Hospital Universitário João de Barros Barreto (HUJBB). No século XX, a doença parecia presa a antigas estruturas e produzia preocupações descabidas, uma vez que o tratamento hoje é rápido e eficaz. Logo emergiram as histórias de outrora, apresentando terríveis imagens da epidemia de cólera ocorrida em 1855. Analisaram-se memórias dos coléricos, de seus parentes e demais protagonistas, e compulsaram-se documentos. Encontraram-se indicações que possibilitam a comparação entre epidemias ontem e hoje, permitindo prever a repetição de tragédias devidas à permanência de condições de vida a que estavam submetidos os pobres nos séculos XIX e XX.

Memórias da cólera no Pará (1855 e 1991): tragédias se repetem? / Memories of cholera in Pará (1855 and 1991): tragedies repeat them selves?

Na epidemia de cólera no Pará, em 1991, o número de vítimas foi elevado, e embora os enfermos se recuperassem rapidamente, relutavam em deixar o hospital. As condições de vida no século XIX eram, guardadas as proporções, semelhantes às enfrentadas pelos coléricos agora atendidos no Hospital Universitário João de Barros Barreto (HUJBB). No século XX, a doença parecia presa a antigas estruturas e produzia preocupações descabidas, uma vez que o tratamento hoje é rápido e eficaz. Logo emergiram as histórias de outrora, apresentando terríveis imagens da epidemia de cólera ocorrida em 1855. Analisaram-se memórias dos coléricos, de seus parentes e demais protagonistas, e compulsaram-se documentos. Encontraram-se indicações que possibilitam a comparação entre epidemias ontem e hoje, permitindo prever a repetição de tragédias devidas à permanência de condições de vida a que estavam submetidos os pobres nos séculos XIX e XX.(AU)

[Memories of cholera in Pará (1855 and 1991): tragedies repeat them selves?]. / Memórias da cólera no Pará (1855 e 1991): tragédias se repetem?

During the 1991 cholera epidemic in the state of Pará, there were a substantial number of victims. Although those stricken recovered quickly, they were reluctant to leave the hospital. Taking proportions into account, nineteenth-century living conditions were similar to the living conditions confronted by the sick receiving care at the Hospital Universitário João de Barros Barreto (HUJBB). In the twentieth century, apparently the illness was still attached to old structures and conjured up worries that are now unnecessary, since today's treatment is fast-working and effective. Stories of days past quickly surfaced, with terrifying images of the 1855 cholera epidemic. In addition to relying on documental sources, the study analyzed the memories of cholera patients, their relatives, and other actors. Findings allow for a comparison between the epidemics of yesterday and of today, in turn permitting the prediction that such tragedies will be repeated because the living conditions of the nineteenth- and twentieth-century poor remain the same.

[The cholera epidemics and the development of public health in Meiji Japan. 2. Strength and weakness of public health politics]. / Le choléra et la naissance de la santé publique dans le Japon de Meiji. 2. Forces et faiblesses d'une politique de santé publique.

We present here the beginnings of public health politics in Meiji Japan (1868-1912). Due to a two century isolation of Japan, public health concepts developed in the West from the end of the 18th century were foreign in premodern Japan. Due to its isolation, Japan was also relatively preserved from some acute infectious diseases such as cholera. In this paper, we investigate the role of cholera epidemics in the emergence of public health concepts in the peculiar context of Meiji Japan. We show that chronic diseases such as tuberculosis and leprosy were neglected for a long time and that the Meiji government set priority on acute infectious diseases that were considered as long as they disturbed public order. Nevertheless, some physicians and government officials considered issues of welfare and poverty. We also review some emerging concepts of social medicine. We try to show that in Japan as well as in western nations public health politics were not exempt of contradictions and paradoxes and a permanent tension existed between coercitive policies and conceptions of welfare and rights to health.

[The cholera epidemics and the development of public health in Meiji Japan. 1. Modernity, cholera, and health thought]. / Le choléra et la naissance de la santé publique dans le Japon de Meiji. 1. Modernité, choléra et pensée hygiénique.

We present here the beginnings of public health politics in Meiji Japan (1868-1912). Due to a two century isolation of Japan, public health concepts developed in the West from the end of the 18th century were foreign in premodern Japan. Due to its isolation, Japan was also relatively preserved from some acute infectious diseases such as cholera. In this paper, we investigate the role of cholera epidemics in the emergence of public health concepts in the peculiar context of Meiji Japan. We show that chronic diseases such as tuberculosis and leprosy were neglected for a long time and that the Meiji government set priority on acute infectious diseases that were considered as long as they disturbed public order. Nevertheless, some physicians and government officials considered issues of welfare and poverty. We also review some emerging concepts of social medicine. We try to show, that in Japan as well as in Western nations, public health politics were not exempt of contradictions and paradoxes and a permanent tension existed between coercitive policies and conceptions of welfare and rights to health.

Public health and the civilizing process.

Since the Middle Ages, European society has passed through two successive stages in the "civilizing process." Each has been attended by profound changes in psychological and social codes. These are examined in relation to a greater concern with health and hygiene in response to four waves of epidemics: leprosy, plague, syphilis, and cholera. Speculations are offered about AIDS and the "civilizing process".