At the end of the fourteenth century, political authorities in Italy recognised the importance of controlling peopleÕs anger and panic during outbreaks of plague. They implemented a number of actions to keep civil order. Their main concern was that less advantage groups in the community might revolute against them because they were unable to escape during times of plague. They attempted to tax rich people who wanted to flee during the outbreaks of the Black Death but this did not work. In the fifteenth century, the awareness of politicians increased and they realized the importance of planning and preparing for outbreaks as well as reducing social disruption. Florentine was the first city in Europe that granted its political magistracy the power to prepare for the next epidemic of plague (Porter, 1999).
Florentine set the first example of outbreak preparedness in Europe at that time. They created a national board to respond to plague epidemics in 1493. They were anticipating that the Black Death might reach their territory from Rome and for this reason they assigned a number of people to monitor and report any sick individual coming from Rome to their city. In addition, they banned public and mass gatherings during times of epidemics. These actions were the basis of public health measures implemented nowadays in the form of travel restrictions and social isolation in order to reduce or delay the transmission of outbreaks. These measures were successful in protecting Florentine and they were the basis for further work on outbreak planning and preparedness. Over the next centuries, other European cities followed the example of the Italian cities and established permanent health committees to manage emerging infections (Porter, 1999).
Political authorities dominated the health boards and physicians were not allowed to be actively involved. Health board main job was to collect information about diseases in the neighbouring countries as well as to guard against imported cases. The power of health boards across Europe grew considerably and they were able to challenge the Church regarding banning religious gatherings to reduce disease transmission (Cipolla, 1973). National authorities supported the board of health whenever they disagreed with the religious authorities. This political commitment to prevent and control infections as well as to reduce the social and economic burden of epidemics was crucial to the work of the health officials at that time. In terms of
funding, health authorities were funded by emergency taxation, which was an area of controversy at that time (Porter, 1999).
Health boards were also responsible for early detection and monitoring of outbreaks. In Florentine, health officials asked all physicians and surgeons to be careful and notify probable cases to the health board. It was believed that the information provided by physicians working in the community and the appointed guards outside cities was important for the health committee to prepare for potential outbreaks in advance (Porter, 1999).
During the eighteenth century, the science of epidemiology was introduced to inform public health practice. Scientists described risk factors, methods of transmission, outbreaks and conducted epidemiologic studies (Nelson and Williams, 2007). John Snow, for instance, conducted an epidemiological study to find out the ways of transmission of cholera in mid-1850 in London (Snow, 1936).
By the beginning of the twentieth century and before the First World War, political authorities supported national and local tiers in their efforts to prepare and mange disease outbreaks (Tomes, 2010). The pandemic influenza in 1918-1919 claimed millions of lives and in order to have a comprehensive understanding about what happened during that time, it is important to refer to the previous pandemic to examine the progress of communicable disease control. Pandemic influenza spread from Russia in 1889 and despite all the progress made in public health knowledge and practice, health authorities were confused about it as demonstrated in the media report by the New York
Times Ò the disease is undoubtedly due to some microorganism which floats in the air, and which infects the human system, but is generally killed in so doing, for influenza is but slightly if at all contagious.Ó (Anon., 1889).
Despite the fact that national and local health officials were anticipating the pandemic to reach the states in few months, they did not do much preparedness and it was left for frontline healthcare workers to manage individual cases rather than applying prevention and control measures. Doctors educated sick people to isolate themselves and advised elderly with underlying illness not to mix with sick individuals (Tomes, 2010).
In the following years, medical microbiology evolved in a steady pace and laboratory techniques were able to isolate causative agents repressible for specific infections, including cholera, syphilis, and anthrax. On the other hand, the science of virology during 1918 pandemic was exploring particles smaller than bacteria, but it was very early to isolate them. Public health officials responded to 1918 influenza pandemic with greater knowledge and understanding when compared to the previous pandemic. Specific messages were implemented such as public education about the importance of hand washing and self-isolation when sick. In addition, infection control measures were widely implemented at that time (Tomes, 1999).
3.6 International efforts to control communicable and infectious diseases