Public Health Tradition in Dubrovnik and Croatia

Zagreb, 8 May 2020 – The formation of the public health system in Croatia was greatly influenced by the work of eminent Croatian doctor Andrija Štampar, who campaigned for its establishment.  Interestingly, principles of responsible public health management were known as far back as in the medieval Dubrovnik Republic. Dubrovnik was one of the global pioneers in implementing the concept of quarantine as the most efficient measure to protect the health of its population in the 14th century, conceiving the culture of a public health system as a weapon against various pandemics.

The institutionalization of public health in Croatia and worldwide

Croatian Professor Andrija Štampar worked as an expert for the Health Organisation of the League of Nations in the European countries and in the United States of America, promoting the importance of establishing a public health system.  In the 1920s, he reorganized China’s public health system. In 1946, he was elected as the first Vice President of the UN Economic and Social Council and the President of the interim commission that performed the World Health Organization’s duties until its Constitution was ratified.  After he presided over the First World Health Assembly of the World Health Organization in Geneva in 1948, Professor Štampar spent some time studying public health and medical education systems in Afghanistan, Egypt, Sudan, and Ethiopia as the WHO’s delegate.

Dr Štampar’s guiding principles underpin public health and social medicine to this day. One of these principles is that there can be no differences between the rich and the poor in public health matters, because public health has more of an economic than a humanitarian significance.

 

Dubrovnik Republic  – the inception of public health culture

In the medieval Dubrovnik Republic, adopting special measures and regulations on the organisation of medical services to prevent infectious diseases from being introduced to the Republic and spreading there was mainly the responsibility of the Councils.

Residents of Dubrovnik referred to all infectious diseases as “pestilent diseases” and to all epidemics as “pestilences” (from Latin pestis = plague).  In 1377, Dubrovnik made medical history by decreeing that “locals and foreigners alike coming from the pestilent areas must not be allowed to enter the City or the area of Dubrovnik before subjecting themselves to a month of cleansing on the island Mrkan and in Cavtat”. The decision, titled “Travellers from Pestilent Areas Banned from Entering Dubrovnik and its Surroundings”, decrees that all persons coming from suspected infection areas or areas where infectious diseases were confirmed must spend 30 days in isolation or quarantine. Historians therefore referred to Dubrovnik’s quarantine as a “trentine”. The decision is written in Dubrovnik’s book of laws, known as the Liber viridis or the Green Book. In the local language, the quarantine building was called lazaret or kontumac.[i]

[i] Content downloaded from the website of the Croatian Institute of Public Health of the Dubrovnik-Neretva County