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Volume 19, Number 9—September 2013

Historical Review

Quinto Tiberio Angelerio and New Measures for Controlling Plague in 16th-Century Alghero, Sardinia

Raffaella BianucciComments to Author , Ole Jørgen Benedictow, Gino Fornaciari, and Valentina Giuffra
Author affiliations: University of Turin, Turin, Italy (R. Bianucci); University of Oslo, Oslo, Norway (O. Jørgen Benedictow); University of Pisa, Pisa, Italy (R. Bianucci, G. Fornaciari, V. Giuffra)

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Table 1

Sanitary measures described in the original text, Ectypa Pestilentis Status Algheriae Sardiniae (1588), by the Protomedicus Quinto Tiberio Angelerio (1532–1617)*

No. Instructions
I
Because the disease is considered a divine punishment, fasts, prayers, vows, and good actions are prescribed to appease the wrath of God.
II
The town must be divided into 10 wards. Each ward must be controlled by a Health Deputy, a person with a high reputation who is invested with full powers. The Health Deputies have the power and the means to 1) punish disobedient citizens without the need to ask for any Magistrate’s advice; 2) set fire to all objects suspected to be infected with plague; 3) close the houses in which plague casualties had occurred; and 4) provide the guards and adopt any mandatory measure needed to guarantee the public health.
III
Through edicts, the population must be warned that citizens who do not declare new plague cases—cases that occur in their houses and in other houses—within 6 hours will be prosecuted.
IV
It is strictly forbidden to have contact with a person suspected to have contracted plague before a physician has ruled out the suspicion.
V
The plague hospital must be kept closed by establishing strict guards, thus avoiding the risk that plague patients will mingle with the rest of the population. All patients will be provided all supplies and medicine needed.
VI
The Health Deputies and the Morbers must gather twice a day in the so-called “City House” to follow the course of the epidemic and to transmit the information to the Councilors who are assisted by the physicians.
VII
Fire must be set to mattresses, fittings, and furniture from all houses in which plague cases have been registered.
VIII
If paupers become ill of a “common” disease and do not want to leave their houses, the city government must provide them with the supplies and medicine that are commonly guaranteed in the hospital.
IX
Meetings, dances, and entertainments are strictly forbidden.
X
When a person is suspected to have died of plague, the corpse must be checked by physicians or surgeons to establish whether the deceased person actually died of plague. If the cause of the death is indeed plague, the relatives of the deceased person must carry the corpse in the courtyard or leave it outside the door.
XI
Two secluded infirmaries must be chosen where persons with plague or suspected to have plague can be isolated. Until these sites are assigned, these persons will be allowed to live in their own houses. However, they should keep themselves separate from the rest of their families as much as possible. Guards will watch over their houses.
XII
Gravediggers should be selected from among persons who had contracted and survived plague during a previous outbreak in another town. Gravediggers must live separately from the rest of the community and far from the hospital. They are not allowed to leave their houses unless accompanied by a Health Deputy.
XIII
Furniture and fittings that are not used must be put aside so that they do not get infected; this will occur until the whole city undergoes disinfection.
XIV
The Councilors and the Jurors of the city of Barcelona (with whom the city has many commercial exchanges) must be immediately informed that a plague outbreak is occurring in Alghero.
XV
Selling entrails of old animals, meat from ill animals, pool fishes, and any other kind of low-quality meat is forbidden.
XVI
Each day, the Morbers and the physicians are compelled to visit all houses suspected to have plague patients and to arrange the hospitalization of these persons into the isolation center (tancat).
XVII
Persons from a house with persons suspected to have plague are forbidden to leave their premises to reach the core of the city. The Morbers are charged to fulfill their needs.
XVIII
If plague affects a person living in a house suspected to have persons with plague, gravediggers must take the patient to the hospital or to the isolation place by moving him/her and the bed in which he/she lies. Leaving a plague patient in his/her own house is absolutely forbidden. The transfer to the tancat has to take place immediately. If the patient is a distinguished person, he is allowed to stay in his own house.
XIX
A red cross must be painted on the doors of houses known or suspected to have persons with plague so that the rest of the population will keep its distance.
XX
The surgeons are not allowed to leave the hospital or the isolation center. They are allowed to leave those structures only to assist other plague patients, and they must be accompanied by the Morbers and the guards.
XXI
Trustworthy persons must be elected to stay in the isolation center and to assist plague patients.
XXII
The pharmacists must provide the poorest with the necessary treatments. A list of the supplied treatments and a list of the citizens must be kept to distinguish between the poorer and the richer. The richer will pay for their treatments, and the city government will pay for the paupers.
XXIII
The city must be cleaned every week from rags and dead things; leather not tanned and rotten raw wool must be put in isolated places; turkeys and cats must be killed and thrown in the sea.
XXIV
It is compulsory to use the Armenian bole for the disinfection of wells and wine casks. Every month, a sack of Armenian bole must be poured in each well. A certain amount also must be added to the wine casks so that they are preserved from the bad quality and corruption of the plague humors.
XXV
A good supply of wood must be provided to light fires in the city and in the houses during the days and nights. Persons must wear perfumes to eliminate or to mitigate the bad quality of the corrupted air.
XXVI
Fire must be set to the infected objects with no peculiar value. High-value furniture must be washed; exposed to the wind; or even better, disinfected in dry heated stoves/ovens.
XXVII
Frequent inventories must be carried out in the pharmacies to guarantee a large stock of medicines and their availability.
XXVIII
Proclamations must be performed to prevent the citizens from going out of their premises and not move from one house to another. It is forbidden to set fire to furniture and fittings without the respective permission. Those not complying with these instructions will be prosecuted.
XXIX
Bells must be rung and cannon balls and artillery fired to purify the air.
XXX
When the physicians diagnose a new plague case, the Morbers must be immediately alerted. They will have the custody of the patient and will take care of him/her.
XXXI
It is compulsory to shut the windows and close the doors of all houses when a person with plague or suspected to have plague is taken to the tancat or to the lazaretto or when a person who died of plague is taken to the cemetery. Perfumes must be worn and bells must be rung so that the citizens pay attention not to contract the bad air (disaura) and, hence, the contagion.
XXXII
It is mandatory to bury plague victims within 6 hours after their death. The corpses must be buried in secluded cemeteries. Long and deep trenches must be excavated, and the corpses must be covered with lime to avoid the air corruption and mephitic vapors. It is forbidden to bury plague victims inside the churches. Citizens who die outside the city walls must be buried in secluded areas.
XXXIII
During the Mass, it is highly recommended to be careful when shaking hands in token of peace.
XXXIV
The beggars and the homeless must be kept outside the city walls during the day to reduce as much as possible their contact with other citizens.
XXXV
All citizens are compelled not to leave their houses. Only 1 member per household is allowed to go out for shopping. Permission to go out has to be granted by the Morber of the area.
XXXVI
People allowed to go out must bear with them a cane measuring 6 feet long. It is mandatory that people keep this distance from one another.
XXXVII
Physicians are compelled to visit all patients. The richest will pay in due time, and the city Councilors will provide for the poorest.
XXXVIII
A large rail, called parabanda, must be positioned in front of the counters in the shops in which meat, bread, wine, and foodstuff are sold so that citizens will keep their distance from the counter itself.
XXXIX
It is mandatory to keep dry stoves/ovens always on. These stoves/ovens are similar to those used to cook the flat tiles (rejolas). The oven’s chamber must be filled with infected textiles/objects after those ones have been washed under the Morbers’ supervision. The chamber must be constantly heated by an underlying lighted fire.
XL
To allow people to confess, 3-window portable confessionals must be prepared. Two windows are positioned laterally and 1 anteriorly so that the confessor is not reached by the patients’ bad breath. For the confessor’s sake, the confessional must be perfumed and kept locked in a chapel not accessible to the common people. When sacraments are administered, the confessional must be transported by the gravediggers directly at the patient’s bedside and must be taken immediately back to the chapel.
XLI
The weekly Head of the Morbers is charged to list all the things entering the lazaretto and the tancat during the week and to attend to all the patients’ needs. Similarly, the Morbers are charged to fulfill the needs of persons suspected to have plague who must stay isolated in their own houses and watched over by the guards.
XLII
The weekly Head of the Morbers must keep the inventory of all the beds, fittings, and furniture that enter into the tancat and the lazaretto. Things showing a good state of preservation will be used to fulfill the patients’ needs, whereas the rest will be burned to avoid the spread of contagion and to avoid robberies.
XLIII
Citizens are forbidden to attempt to cure themselves in their own premises. All ill persons and persons suspected to have plague must be carried to the tancat or to the lazaretto. Guards must accompany these persons and keep other citizens away during the transfer.
XLIV
All infected textiles and objects from the lazaretto must undergo laundry and then disinfection in the dry oven.
XLV
During summertime, bonfires must be set in wooden areas to purify the air taking care not to damage the land’s owners.
XLVI
Infected infants who are orphans or do not have a wet nurse must be bottle fed by using the milk of well-fed goats. For this purpose, goats will be allowed to live inside the lazaretto.
XLVII
The buboes of plague patients must be cut open or cauterized. Those who are reluctant must be tied so that surgeons can intervene.
XLVIII
People suspected to be infected and convalescents must undergo quarantine before they are allowed to get back in contact with healthy inhabitants.
XLIX
When the plague epidemic is close to its end, a high number of male and female goats will have to be introduced within the city walls during the night. The animals will be placed inside the houses of the plague patients, and this operation will be repeated for several nights. However, for the population’s sake, the houses also will undergo whitewashing. Whitewashing will be performed by painters who survived the contagion. For the less suspected houses, it is required that the windows be kept wide open and that perfumes be sprayed and all surfaces washed with vinegar.
L
People living in the surroundings are forbidden to enter the city walls unless their health status has been carefully checked and permission from the Morbers granted. The Morbers are entrusted to check that these persons’ belongings be washed and disinfected in the oven. Once these persons have been proved to be healthy, they will be admitted to live in their new houses but only after their own disinfection. Once they have settled down in their new houses, these persons are compelled to stay isolated from the rest of the population for some days.
LI
The houses’ owners and the lodgers are compelled to disinfect, whitewash, ventilate, and water their residences. In case they do not attend the task, the city government will have to bear the costs.
LII
It is strictly forbidden to sell linen, silk, cotton, and wool textiles without permission from the Morber of the area.
LIII
The Morbers are compelled to carry out the complete disinfection of the city afterward and house after house. The darkest houses and those lacking aeration will be whitewashed, perfumed, and cleaned with vinegar. Bonfires will be set all around. Similar precautions will be applied to the houses whose walls are covered with golden slivers and leathers. Silk, cotton, linen, and woolly textiles must be washed and disinfected in the oven.
LIV
Once all these precautions have been taken, the Councilors, the Deputies, the hospital attendants, and the physician Angelerio himself [the other anonymous physician had already died of the plague] must visit all the Alghero inhabitants, house after house. The citizens will be asked under oath if the Morbers had indeed disinfected their houses properly. In case disinfection had not properly been performed, another will be carried out within the following 6 days.
LXV
It is compulsory that all citizens expose to the wind the furniture and fittings from their houses for 10 days. When the Counselors visit the citizens, at the end of the epidemic, everything must be in order.
LXVI
Each citizen who is aware that his neighbors have not carried out the disinfection properly must notify it to the Councilors and Morbers. The latter will keep the secret and will pay the honest citizen with a money consideration.
LXVII It is compulsory to disinfect the tancat and the lazaretto located outside the city walls by using the same methods described in Instruction LIII. Fire must be set to every object kept inside the above structures. The persons who have survived and complied with the quarantine will be allowed to return to the city wearing new and disinfected clothes. The main city hospital, Sant’ Antonio, must be disinfected and reordered. The hospital will be reopened to all the population and will go back to its standard use.

*Morbers, the health or plague guardians. The Morbers’ task was to watch over the sanitary conditions of the ships docking at the island’s harbors and assist the Protomedicus during the plague outbreaks. The usual Morbers’ duties were largely extended during the 1582–1583 plague outbreak; tancat, isolation center for persons suspected of having plague; lazaretto, Isolation center for plague patients; Armenian bole, a ferruginous, ochreish, red clay used as a therapeutic substance against plague and all types of poisons.

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