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.

Microbial Genomics of Ancient Plagues and Outbreaks.

The recent use of next-generation sequencing methods to investigate historical disease outbreaks has provided us with an unprecedented ability to address important and long-standing questions in epidemiology, pathogen evolution, and human history. In this review, we present major findings that illustrate how microbial genomics has provided new insights into the nature and etiology of infectious diseases of historical importance, such as plague, tuberculosis, and leprosy. Sequenced isolates collected from archaeological remains also provide evidence for the timing of historical evolutionary events as well as geographic spread of these pathogens. Elucidating the genomic basis of virulence in historical diseases can provide relevant information on how we can effectively understand the emergence and re-emergence of infectious diseases today and in the future.

[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.

The plague of the Philistines and other pestilences in the Ancient World: exploring relations between the religious-literary tradition, artistic evidence and scientific proof.

In ancient times the term pestilence referred not only to infectious disease caused by Yersinia pestis, but also to several different epidemics. We explore the relations between references in the Bible and recent scientific evidence concerning some infectious diseases, especially the so-called Plague of the Philistines and leprosy. In addition, some considerations regarding possible connections among likely infectious epidemic diseases and the Ten Plagues of Egypt are reported. Evidence suggesting the presence of the rat in the Nile Valley in the II millennium BC is shown; a possible role of the rat in the plague spreading already in this historical period should be confirmed by these data. While the biblical tale in the Book of Samuel may well report an epidemic event resembling the plague, as to date this infectious disease remains unknown, it is not conceivable to confirm the presence of leprosy in the same age, because the little palaeopathologic evidence of the latter disease, in the geographic area corresponding to Egypt and Palestine, is late, dating back only to the II century AD.

[Infamous rooms or: the dead birds of Lyon. The accomodation of sick men about the year 1800, befor the establishment of a pavilion system]. / Infame Räume oder: Die toten Vögel von Lyon. Zur Unterbringung erkrankter Menschen um 1800 vor der Etablierung des Pavillonsystems.

The contribution follows an architectural perspective on the history of hospitals that are conceptualised as locations of Christian charity. It goes into the German, Italian, and especially into the French developments, and it identifies three types of hospitals in 18th century: That of Christian charity, the military lazaretto, and the new prototypes of modem clinics. Furthermore three technical types are identified, according to the ventilation of the ,machines a guérir' (Tenon): the partial system, the central system, and the technical system.

The social impact of medicine. Chapter 4

This paper, an overview of medical history, is based on a course I taught at the University of Delaware´s Academy of Life Long Learning, "Medicine, the Old and the New". It will not be a chronolgy of medical events and discoveries, but a discussion of the social aspects of medicine, how medicine affected the everyday lives of people, from the religion-based medicine of antiquity to the super-scientific medicine of today. it will consist of 25 chapters. Dr. Peter V. rocca, Editor-in-Chief of the Delaware Medical Journal (DMJ), is planning to publish one chapter in each successive issue of the DMJ.

[Health service organization during the age of pestilence. 2]. / Excursus sull'organizzazione dell'assistenza in tempi di pestilenza. Seconda parte.

The author presents the history of the places where patients with epidemic pathologies were isolated. Since the study of medicine began, such places have been known as asclepiei, xenodochi, hospices, lazarettos, sanitary cordons, and quarantine stations and they contributed to controlling epidemics in Europe. Important not only in the context in which they were created, these structures expressed the medical culture and point of view of that age. Although very far from discovering the cause of the pathology due to their lack of scientific knowledge, the medical class sometimes knew how to effectively organize the isolation of patients. The history of such structures interweaves with the long history of Christianity and with the emerging nations of Europe and the city-states of the Italian Renaissance. Previously, in classical Greece and Imperial Rome there had also been "homes for the sick" to isolate patients. Today the world is periodically hit by epidemics. In such moments the medical profession uses its research ability and organizational capabilities but also historical memory to reduce epidemic contagion.

Hertfordshire medieval hospitals.

All Hertfordshire's hospitals were small, although some had considerable endowments, e.g. St Julian's Hospital at St Albans. Most were in decline by the late 15th Century, or had ceased to function.

Diseases in European historical populations and their effects on individuals and society.

Traditionally, populations are considered "historical" when first written evidences appear. Cultural development with all it's features--agricultural innovations and as a consequence--population growth, social specialisation and stratification, and finally--urbanisation trigger new environmental conditions, among them also in epidemiological situation, that have the feedback effects on the population and the individual. At this time only qualitative evaluations on many of questions can be presented. This paper is an attempt to synthesize available data on the following specific topics related to Medieval/Early Modern European population welfare: nutritional intake, malnutrition and famine; great epidemics and their consequences; spreading of specific infectious diseases (tuberculosis, syphilis, leprosy), which also had a great social resonance in those times, professional diseases. Considerations on their impact on demographical situation (life expectancy, birth rate), life quality and physical development and body build of an individual are also presented. Finally, possibilities for directional selection and impact on modern genetic diversity in Europe are discussed.

El hombre y sus epidemias a través de la historia / Man and his epidemies through history

Llegamos al resumen de hitos respecto a las observaciones o intuiciones y sus consecuencias. 1. Naturaleza contagiosa: escape. 2. Aislamiento forzado o voluntario. 3. Período de contagio: cuarentena. 4. Agente infectante (emanación): desinfección. 4. Inmunidad de los sobrevivientes: variolizalación. 5. Vías de trasmisión: medidas sanitarias. 6. Los microbios: vacunas, antitoxinas, antibióticos. 7. Retorno al principio: VIH, Ebola-Reston, Hantavirus. Reaparecen las escenas de terror con el Ebola en los hospitales africanos, donde no quieren atender a los enfermos. Los laboratorios rehusan trabajar el virus, alegando insuficientes condiciones de seguridad. Con el conocimiento adquirido a través de siglos de terror y de mortandad, hoy los pasos son más acelerados, pero las reacciones son las mismas, como lo ilustra el SIDA, que recuerda a todas las pestes: la muerte al azar (cólera), el temor y el rechazo (el perro rabioso), la segregación y la muerte en vida (lepra), el castigo a la vida licenciosa (la sífilis), la muerte inevitable, lenta y contagiosa (tuberculosis) y los hombres de iglesia, abriendo sus brazos sin temor al contagio, allí donde los médicos vacilan. Se cierra el ciclo que esbocé al comienzo y que une, en una misma reacción visceral, al hechicero cro-magnon con el médico especialista. Sin embargo, de esta visión del pasado surge una visión optimista: siempre el hombre ha terminado por prevalecer frente a las más tremendas epidemias