The origins of the health defence system against contagious illness: the strategies of isolation and quarantine in Mediterranean cities from the XIV-XIX centuries.

From the onset of the Black Death in 1347-48, Italian cities which faced the Mediterranean, an epidemic sea, constructed a complex and articulated health defence system which was an example to all other western countries. The cornerstones of this health defence system lay in quarantine, sanitary cordons, lazarets, disinfection, and in the social regulation of the population at risk. Medicine played no part. Its impotence in dealing with epidemic diseases left health defence to the initiative of the civil authorities who rigorously fought the repeated incursions of plague, which from the end of Middle Ages severely tried and tested social organisation, economic life and public order, all of which were threatened by reactions of fear and aggression. From the fifteenth century onwards the public authorities instituted health magistracies which perfected policing and hygiene strategies based on isolation, separation and social control. This progressively extended to individuals in the community through 'health certificates'. This paper follows the evolution and crises of the conceptual, cultural adn institutional response to epidemics through the centuries up to the appearance of the plague of cholera and its disappearance.