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.
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.
The Council of Lyons restricts lepers from freely associating with healthy persons.
China has a well-established policy to detain plague-stricken sailors and foreign travelers who arrive in Chinese ports.
The Third Lateran Council decrees living arrangements for lepers and how their necessary separation from society is to take place.
Europe now has some 19,000 leprosaria, or houses for leper patients; France alone boasts roughly 2,000.
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.
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.
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."
Venice establishes the world's first known maritime quarantine station, or lazaretto, on Santa Maria di Nazareth, an island in the Venetian lagoon.
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.
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.
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.
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.
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.
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.
When the plague epidemic reaches Russia, officials organize quarantines and prohibit entry into Moscow of people from other countries, under threat of death.
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.
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.
A Massachusetts statute stipulates that all individuals suffering from plague, smallpox, and other contagious diseases must be isolated in separate houses.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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."
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.
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.
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."
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.
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.
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."
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.
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.
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.
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).
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.
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."
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.
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.
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.