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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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