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7. Completely banning pigs from wandering the streets.
8. Carrying out cleaning and sanitation of drainage pipes and
sewers or any other places which could be a source of infec-
tion within the town limits.
9. Carrying out a thorough inspection of all meat and fish
destined for human consumption as well as vegetables, legu-
mes, fruits or any other food substances and their respective
selling posts or collection points.
10. Banning of clothes washing in streams passing through
the towns or within the town limits.
11. Finally, by setting up a surveillance service at the entran-
ce to the town in order to carry out any necessary measures
demanded by the competent authority [33].
Therefore, as a result, the epidemic of yellow fever almost
exclusively affected coastal areas and areas close to navigable
rivers [34], as these were the natural entry points of a disease
which was brought fromAfrica and America.
The problem of the mixing of drinkable and contaminated
water was a serious cause for concern especially in big urban
areas. Therefore every possible effort was made to improve
water distribution services as well as to deal with residual
or dirty water, thereby contributing to the struggle against
transmittable diseases throughout the XIX century [35]. In
1804, it became mandatory to separate rain water and water
coming from fountains, springs or wells from residual water
coming from drain pipes [36].This law forced governments
in power during the second half of the century to make a
big effort to sanitize and supply clean water to the cities and
towns, as well as to set up an incipient International Health
Service whose aim was to control transmittable diseases by
organising International Health Conferences [37].
The measures taken to avoid infection were a combination
of both medical and military, thereby proceeding to isolate
members of the population who were affected by the disease.
This form of isolation and incommunication were the most
effective measures to deal with infection among people.
However, protests were held as people demanded help and
assistance. Poverty increased sharply in large cities where
the needy gathered to seek help from charity organisations
which were set up to deal with the problems.The Supreme
Board of Health announced on the 21 February, 1833 to the
Provincial Health Authorities, the need to establish quaran-
tines in Galicia, Castilla laVieja, Extremadura and Andalucía
thereby preventing entry to individuals coming from Portu-
gal, this was done with help from the Armed Forces [38].
Carlos Cipolla, referring to health measures taken during
the first epidemic of cholera, states that they were “...an al-
most identical replica of what was done previously in the
north of Italy during the XVI, XVII and XVIII centuries” [39:
21], based on the miasmic theory [40] which claimed that
“the diseases were related to the quality of the air depending
on whether its saturation of Pestilence was higher or lower”
[41:203], and atmospheric medicine which could have come
from classical Greece, basing itself on the humoral doctri-
ne and the geographical location, which reached its highest
peak in the XVIII century [42].The first significant measure
taken in atmospheric medicine was the Act of Public Health
in 1848, but it wasn’t until another law was passed in 1875
that some atmospheric factors began to be effectively con-
trolled [43].
In the Instruction for the Economic - Political Government
of Provinces, dated 13
th
June 1813, measures and initiatives
adopted by the different towns during the XIX century were
specified in detail:
The Police Authorities who are responsible for the local town councils
and the health and well-being of the people have the duty to control
the cleaning of housing, markets, public squares, hospitals, prisons
and charity houses as well as keeping a check on all foodstuffs. Each
town must have an adequately located burial ground and care must
be taken of stagnant water or contaminated water
drainage.Tosum
up, it must be ensured that nothing in the vicinity of the town alters
or affects the health of the population or its livestock in any way
[44: 257-258].
Not many studies are available which outline the evolution
of health infrastructure in the towns of the south-west of
Extremadura [45, 46, 47,48], “what is worth outlining is that
the knowledge of the history of urban reality is not just a
task left to expert researchers of past events, in search of a
need to satisfy a huge intellectual curiosity embedded in the
general process of promoting historical consciousness. It is
a means of getting a closer understanding of today’s reality,
finding out how things became what they are, in this case,
how our towns acquired their current features. In order to
understand this, we need to see these towns placed within a
corresponding process of formation. It is necessary to obser-
ve urban reality as a result of history” [49:82].
The water supply to towns was normally distributed by pu-
blic sources, situated in the town centre and also wells in
the outskirts of the towns [50]. It was a complicated task for
towns to control consumption and as a result, there were of-
ten periods of drought during the summer season or during
other dry spells of weather [51]. The Romans managed to
construct an important network in Merida which required
large sums of money to keep it going [52].
Conclusions
The best way of controlling yellow fever is by vaccination
but it is also of paramount importance to control the Aedes
aegypti mosquito to avoid the insect becoming urban.A sys-
tem of detection through vigilance and control of epidemic
breakouts is
also crucial. These measures can be difficult to
implement in certain parts of the world precisely where the
mosquito is active. This is due to its elevated cost, lack of
infrastructure, lack of qualified professionals, etc. Epidemics
often originate in rural areas, far from urban places which
Medicina tropical e ambiente