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The practice of quarantine—the separation of the diseased from the healthy—has been around a long time.
As early as the writing of the Old Testament, for instance, rules existed
for isolating lepers. It wasn't until the Black Death of the 14th century, however,
that Venice established the first formal system of quarantine, requiring ships
to lay at anchor for 40 days before landing. ("Quarantine" comes from the Latin
for forty.) The Venetian model held sway until the discovery in the late 1800s
that germs cause disease, after which health officials began tailoring
quarantines with individual microbes in mind. In the mid-20th century, the
advent of antibiotics and routine vaccinations made large-scale quarantines a
thing of the past, but today bioterrorism and newly emergent diseases like SARS
threaten to resurrect the age-old custom, potentially on the scale of entire
cities. In this time line, follow the evolution of quarantine, from Roman times
to the present.—Peter Tyson
A.D. 549
In the wake of one of history's most devastating epidemics of bubonic plague,
the Byzantine emperor Justinian enacts a law meant to hinder and isolate people
arriving from plague-infested regions.
583
The Council of Lyons restricts lepers from freely associating with healthy
persons.
600s
China has a well-established policy to detain plague-stricken
sailors and foreign travelers who arrive in Chinese ports.
1179
The Third Lateran Council decrees living arrangements for lepers and how their
necessary separation from society is to take place.
1200
Europe now has some 19,000 leprosaria, or
houses for leper patients; France alone boasts roughly 2,000.
1300s
A number of European and Asian countries begin
enforcing quarantines of infected regions by encircling them with armed guards.
Those caught escaping from afflicted areas are returned and sometimes executed
as a warning to others.
1348
Venice establishes the world's first institutionalized system of quarantine,
giving a council of three the power to detain ships, cargoes, and individuals
in the Venetian lagoon for up to 40 days. The act comes in the midst of the
Black Death, a plague epidemic that eventually takes the lives of 14 to 15
million people across Europe, or up to one-fifth of the population.
1374
The Duke of Milan draws up an edict mandating that all those suffering from
plague should be taken outside the city to a field or forest until they either
recover or die. Three years later, the town of Ragusa establishes a quarantine
station where all people arriving from plague-infested regions are kept
isolated for a month for "purification by sun and wind."
1403
Venice establishes the world's first known maritime quarantine station, or
lazaretto, on Santa Maria di Nazareth, an island in the Venetian lagoon.
1521
France's first maritime quarantine opens at Marseilles. A century later, city
officials enact a law forbidding travelers from entering the city without a
preliminary medical examination.
1629
Sanitary legislation drawn up in Venice requires health officers to visit
houses during plague epidemics and isolate those infected in pest-houses
situated away from populated areas.
1647
With infectious diseases in mind, officials in Boston draw up an ordinance
requiring all arriving ships to pause at the harbor entrance or risk a $100
fine.
1656
After a plague epidemic kills 100,000 people in Naples, Rome begins inspecting
all incoming ships and patrolling its border in hopes of keeping the plague
out. When Romans start dying from plague in the city's Trastevere slum and
Jewish ghetto, officials seal and monitor these districts. It does little good:
in the coming months, about 10,000 people in Rome succumb to plague.
1663
During a smallpox epidemic in New York City, the General Assembly passes a law
forbidding people coming from infected areas from entering the city until
sanitary officials deem them no threat to residents.
1663
With plague ravaging parts of continental Europe, the English monarchy issues
royal decrees calling for the establishment of permanent quarantines. All
London-bound ships, whether English or foreign, must pause at the mouth of the
Thames River for 40 days (and sometimes 80). The quarantine fails, however, to
stave off the disease, which assails the country in 1665-1666.
1664-1665
When the plague epidemic reaches Russia, officials organize quarantines and
prohibit entry into Moscow of people from other countries, under threat of
death.
1666
The city of Frankfurt issues a decree prohibiting people living in
plague-infected houses from visiting churches or markets, and from removing and
selling the clothing of plague victims without first fumigating, washing, and
airing the garments.
1700s
All major towns and cities along the eastern seaboard of the
United States have now passed quarantine laws, though typically these laws are
enforced only when epidemics appear imminent.
1701
A Massachusetts statute stipulates that all individuals suffering from plague,
smallpox, and other contagious diseases must be isolated in separate houses.
1712
A plague epidemic around the Baltic Sea leads England to pass the Quarantine
Act. During a mandatory 40-day quarantine for arriving ships, goods cannot be
removed, and serious breaches of the act can result in the death penalty.
1738
With smallpox and yellow fever threatening to strike New York, the City Council
sets up a quarantine anchorage off Bedloe's Island (home of the Statue of
Liberty today). The island becomes a quarantine station for contagious
passengers and crew from arriving ships.
1799
With memories still fresh of a nasty 1793 yellow fever epidemic that struck
Philadelphia, then the capital of the United States, the city builds an
expansive quarantine station called the Lazaretto along the Delaware River
about 10 miles south of town. Occupying ten acres, the building still exists
today.
1808
The Boston Board of Health orders that, between May and October of every year,
ships arriving from the Caribbean, Mediterranean, and other tropical ports be
quarantined for three full days or until 25 days have passed since they left
port, whichever is longer.
1832
After about 30,000 people in Britain alone die in a cholera epidemic in
1831-1832, New York mandates in June 1832 that no ship can approach within 300
yards of any dock if its captain suspects or knows the ship has cholera aboard. The disease
slips through the safety net, however, killing nearly 3,500 of the city's
250,000 residents before it ends in September.
1850-1851
Following horrific epidemics of plague and cholera that spread through Europe
from Egypt and Turkey towards the middle of the 19th century, the first
international sanitary conference is held in Paris, with an eye to making
quarantine an international cooperative effort. These sanitary conferences
continue well into the 20th century.
1863
New York State's new Quarantine Act calls for a quarantine office run by a
health officer who has the power to detain any ship entering the port of New
York for as long as he deems necessary. The health officer can also order all
cargo to be removed and a ship cleaned and fumigated.
1866
In April the steamer Virginia arrives in New York harbor from Liverpool,
its passengers riddled with cholera. Discovering that 35 steerage passengers
and two crew have died during the voyage, the city's health officer orders a
swift quarantine. This and other strict quarantines undertaken during the
ensuing epidemic prove successful in limiting deaths to about 600, a modest
number compared to previous outbreaks.
1879
Amid concern about yellow fever, the U.S. Congress establishes the National
Board of Health, in part to assume responsibility for quarantine in cases where
states' actions had proven ineffective. The board tries but fails to impose a
national quarantine, and it dissolves for lack of funding in 1883.
1890s
As the era of bacteriology arrives, with major diseases like typhoid and
cholera determined to arise from germs, the length and nature of quarantine
evolves, now often based on the life cycles of specific microbes.
1892
When an Asiatic cholera epidemic reaches the U.S. in the fall, President
Benjamin Harrison has his surgeon general issue an order holding that "no
vessel from any foreign port carrying immigrants shall be admitted to
enter any port of the United States until such vessel shall have undergone
quarantine detention of twenty days, and such greater number of days as may be
fixed in each special case by the State authorities."
1893
The U.S. Congress passes the National Quarantine Act. The act creates a
national system of quarantine while still permitting state-run quarantines, and
it codifies standards for medically inspecting immigrants, ships, and cargoes,
a task now in the hands of the federal Marine Hospital Service.
1894
Epidemics of plague in China, Hong Kong, and Taiwan, as well as in India two
years later, fly in the face of arguments promulgated by most European
scientists of the day that the widespread scourges that ransacked Europe in the
Middle Ages are history.
1900
In March, Chick Gin, the Chinese proprietor of a lumberyard, dies of bubonic
plague in a flophouse in the Chinese quarter of San Francisco. Authorities
immediately rope off the 15-block neighborhood, quarantining roughly 25,000
Chinese and closing businesses owned by nonwhites. In June, a court rules the
quarantine racist and lifts it, declaring that health officials acted with an "evil
eye and an unequal hand."
1902
The Pan American Sanitary Bureau is established. It is the first of a series of
international health organizations formed in the 20th century—culminating
with the World Health Organization in 1948—that help to bring issues of
quarantine and the control of disease to a global stage.
1903
In an attempt to isolate tuberculosis patients, the New York City Department of
Health opens a quarantine facility at Riverside Hospital on North Brother
Island, an islet in the East River. Mary Mallon, aka "Typhoid Mary," begins
what becomes a total of 26 years of quarantine here in 1907. (For more on
Mallon's quarantine, see In Her Own Words and Typhoid Mary: Villain or
Victim?.)
1916
When an epidemic of poliomyletis strikes New York residents, authorities begin
forcibly separating children from their parents and placing them in quarantine.
Wealthy parents, however, can keep their stricken children at home if they can
provide a separate room and medical care. By November the epidemic has runs its
course, but not before killing more than 2,300 mostly young New Yorkers.
1917-1919
During World War I, American authorities incarcerate more than 30,000
prostitutes in an effort to curb the spread of venereal disease. The historian
Allan Brandt has called this effort "the most concerted attack on civil
liberties in the name of public health in American history."
1944
The Public Health Service Act is codified, clearly establishing the quarantine
authority of the federal government, which has controlled all U.S. quarantine
stations since 1921.
1945
In Baltimore, the mayor passes an ordinance giving health authorities the power
to isolate at the city's hospitals those patients with syphilis or gonorrhea
who refuse penicillin treatment. The ordinance is rarely invoked, however, as
the treatment takes at most only a few days, and most patients willingly accept
the assistance.
1949
To help stem the spread of tuberculosis, Seattle creates a locked ward for TB
sufferers who deny treatment. The ward becomes a model for other cities.
1967
The U.S. Department of Health, Education, and Welfare transfers responsibility
for quarantine to the National Communicable Disease Center, now the Centers for
Disease Control and Prevention (CDC).
1986
Treating the first cases of HIV/AIDS in the country as a public health emergency,
Cuba begins compulsory, indefinite quarantine for citizens testing positive for
HIV. Three years later, rules are relaxed to allow such patients to leave sanatoriums
for long stretches, and beginning in 1993, HIV patients can choose to live at home
after an eight-week course at a sanatorium.
1990s
To help control multidrug-resistant tuberculosis, New York City detains more
than 200 people who refuse voluntary treatment, confining most of them to the
secure ward of a hospital for about six months. One patient said the hardest
part of this enforced treatment was "being bored like an oyster."
2001
In the wake of the September 11 terrorist attacks, health officials, at the
behest of the CDC, release in December a draft of the proposed Model State
Emergency Health Powers Act. The act gives states greater powers to quarantine
people in the event of a bioterrorist attack involving a lethal microbe such as
smallpox. By July 2002, emergency health powers legislation has passed in 19
states and been introduced in 17 others.
2003
An outbreak of severe acute respiratory syndrome, or SARS, in Asia and Canada
occurs in the spring. Officials credit the use of both isolation (for those
sick with SARS) and quarantine (for those exposed to the sick) with
forestalling an even more severe epidemic. In April, President George W. Bush
adds SARS to the list of quarantinable diseases, which also include cholera,
diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, and viral
hemorrhagic fevers such as the Ebola and Marburg viruses.
2004
The Division of Global Migration and Quarantine, part of the CDC's National
Center for Infectious Diseases, controls quarantine issues in the United States
today. The Division oversees eight national quarantine stations—in New
York, Atlanta, Miami, Chicago, Seattle, San Francisco, Los Angeles, and
Honolulu. At present, federal, state, and some city health officials have the
right to isolate or quarantine individuals who are ill or may become ill with a
potentially lethal infectious disease.
Sources
AIDS: The Burdens of History
edited by Elizabeth Fee and Daniel M. Fox. Berkeley: University of California
Press, 1988
Contagion and Containment: Controlling Tuberculosis Along the Skid
Road
by Barron H. Lerner. Baltimore: Johns Hopkins University Press, 1998
A History of Public Health
by George Rosen. Baltimore: Johns Hopkins University Press, 1993
A History of Public Health in New York City 1866-1966
by John Duffy. New York: Russell Sage Foundation, 1974
International Quarantine
by Oleg P. Schepin and Waldemar V. Yermakov. Madison, CT: International
Universities Press, 1991
Quarantine! East European Jewish Immigrants and the New York City Epidemics
of 1892
by Howard Markel. Baltimore: Johns Hopkins University Press, 1997
Public Health Law and Ethics: A Reader
edited by Lawrence O. Gostin. Berkeley: University of California Press, 2002
Silent Travelers: Germs, Genes, and the "Immigrant Menace"
by Alan M. Kraut. New York: Basic Books, 1994
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