Eleanor Klebanoff's Article 'A Brief History of Quarantine: From Rinderpest to Typhoid Mary'

A Brief History of Quarantine: From Rinderpest to Typhoid Mary

Eleanor Klebanoff

Translator: Ramin Khajehpour

(Typhoid Mary is the name of the typhoid fever spread by an Irish cook named Mary in early twentieth-century New York)

China is establishing a quarantine center around the city of Wuhan, where the newly discovered virus has infected hundreds of residents.

The idea of quarantining individuals with contagious diseases dates back to ancient texts. The Book of Leviticus in the Old Testament describes how to quarantine persons afflicted with leprosy. Hippocrates, the father of medicine in ancient Greece, wrote on epidemics in a three-part treatise, although he lived in antiquity, when it was believed that disease was transmitted through foul air or a malodorous gas rising from the earth.

In light of the recent news about the establishment of quarantine, we take a look at the right and wrong uses of quarantine throughout history.

Rinderpest in Venice, 1370

What is called the Black Death killed twenty million people in Europe in the fourteenth century. If authorities suspected a ship's passengers of having the plague, the ship had to remain suspended on the water for forty days, without the passengers or goods being unloaded. The Venetians built a quarantine hospital center on an island near the coast to which sailors afflicted with the plague were sent, where they would either be treated or, more likely, die. This forty-day period became known as quarantenario, derived from the Italian word quarantina, or quarantine, meaning forty days. When views on the disease changed, the forty-day period was reduced to thirty days—trentinario in Italian—but the original name became widespread and stuck.

Yellow Fever in Philadelphia, 1793

As a result of this disease, nearly 5,000 people died over a two-year period, almost one-tenth of the city's population. Thousands fled to surrounding towns, and at the peak of the epidemic, when nearly a hundred people were dying daily, the local government collapsed. Philadelphia was the nation's capital, but federal government officials fled instead of confronting the disaster. The best treatment for the disease at the time was to bleed the infected area and give the patient wine—and a popular theory for stopping the disease was to confine sailors in the Lazaretto, a hospital outside the city. But the disease was transmitted by mosquitoes, and the quarantine was no more effective than the cold, dry air that killed the insects carrying the disease.

Typhus in New York, 1892

In 1892, a boat carrying a large number of Russian Jewish immigrants arrived at Ellis Island. Passengers in the steerage compartments had transmitted a type of louse that led the port inspector to say, "I had never seen such a filthy group." According to the books of Howard Markel, a renowned physician and medical author, the lice led to typhus, but as the disease manifested, the passengers went to see their families in their tenement houses on the Lower East Side of New York. At least seventy people were rounded up and quarantined in tents on North Brother Island in the East River. The cholera outbreak in New York continued from a ship carrying more Russian Jewish immigrants. According to Dr. Markel, the front page of the New York Times ran the headline, referring to Russian Jews, "We do not need these filthy people on our shores." He notes that this was not an editorial.

Rinderpest in San Francisco, 1900

After forcing Caucasians to leave the city, San Francisco authorities cordoned off six city blocks with barbed wire and rope. The reason was fear of rinderpest, following the discovery of a Chinese immigrant's body in a hotel basement. The quarantine was lifted after a few days, but not before a large number of Chinese workers were dismissed. The incident became known in the newspapers as the "disease bluff," a bluff that led to abhorrent decisions—though these decisions were never implemented—concerning the repatriation of many Chinese immigrants.

Typhoid in New York City, 1907

You may have heard of "Typhoid Mary." Mary was an Irish-born cook who carried the typhoid bacteria in her body, a salmonella bacterium that causes fever, nausea, and death. But Ms. Mary Mallon herself was immune to the disease. When authorities discovered that her work as a cook had caused outbreaks in the city, they sent her to an island called North Brother to be quarantined for three years. She promised never to cook for anyone again. But she broke her promise. (She is also credited with inventing peach ice cream.) When she was arrested, she was sent back to the same island to remain there for the rest of her life, which spanned more than twenty-three years.

Venereal Disease in the United States, 1917

As World War I escalated, the number of young men with contagious venereal diseases who were unfit for military service increased. This worried the U.S. Army. These young men were contracting diseases such as syphilis and gonorrhea. Authorities also noticed an increase in these diseases in girls' camps; they found that prostitutes and other women were loitering around the girls' training grounds and army recruitment sites. The federal government issued an order that all prostitutes be arrested and tested. Harvard medical historian Allan Brandt estimates that at least thirty thousand women were arrested in a sudden sweep. He says: "There is no evidence that this measure affected the rate of disease transmission." "But there was a belief that these women posed a serious threat to the success of the war." He adds that when the women were rounded up and sent to prison, even long after their test results came back negative, the army would sentence them to be sent to France as soldiers.

The Influenza Pandemic in Europe and America, 1917–1919

This pandemic, which killed approximately fifty million people, led to quarantine and isolation, school closures in Europe, and restrictions on public gatherings in parts of the United States. These measures temporarily contained the disease and ultimately, in the words of medical historian Markel, constituted "a massive social disruption." Influenza is one of the most contagious diseases in the world. Spending a few minutes next to someone who is sneezing and has a runny nose is enough for the disease to be transmitted. Markel says that, in comparison, you have to spend eight hours with a tuberculosis patient to contract TB.

SARS in Canada, 2003

The SARS (Severe Acute Respiratory Syndrome) pandemic in 2003 led to quarantines in many countries. Canada's response was one of the most disproportionate measures taken to confront the risk. According to a report by the U.S. National Institutes of Health, Canada quarantined roughly one hundred people for every case of SARS. Although Toronto had approximately 250 probable cases of the disease, about thirty thousand people were confined to their homes or hospitals. In Beijing, China, 2,500 people were quarantined.

Rinderpest in China, 2014

At the beginning of the new century, when faced with a case of bubonic plague, China was able to open a new chapter in the fight against the disease. In the Chinese city of Yumen, a man gave a dead marmot to his dog to eat. Apparently, the marmot was a carrier of the plague. After this incident, authorities quarantined all 151 people who had contact with the man. Many neighborhoods in the city were sealed off, resulting in thousands being quarantined. Yanzhong Huang, an official at the World Health Organization, said in an interview with The Guardian: "SARS taught Chinese authorities the wrong lesson—that quarantine works like a magic trick for combating any dangerous, contagious, and infectious disease." After two days, the quarantine was lifted, and no other cases of the disease were reported.

Ebola in Liberia and Sierra Leone, 2014

In Liberia, after medical trainees set up a holding center for suspected patients in the West Point neighborhood, a sanitary cordon was drawn around the area for ten days (to control the movement of suspected individuals). After some patients fled into this impoverished neighborhood, the government decided to quarantine the area for twenty-one days (the incubation period of the disease). Protests ended the quarantine after ten days. In neighboring Sierra Leone, a three-day quarantine was declared in September, and people were asked to stay at home so that health workers could visit every house to identify sick individuals and also deliver bars of soap to each home. Médecins Sans Frontières, which played a key role in fighting Ebola, says, "We have learned from experience that lockdowns and quarantines do not help control Ebola; rather, such measures drive communities into isolation and concealment, and jeopardize trust between medical staff and the people."

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A History Of Quarantines, From Bubonic Plague To Typhoid Mary

China is building a quarantine center on the outskirts of the city of Wuhan, where a newly identified virus has infected many hundreds of residents.

The idea of putting a possibly sick person in quarantine goes back to the ancient texts. The book of Leviticus tells how to quarantine people with leprosy. Hippocrates covered the issue in a three-volume set on epidemics, though he came from a time in ancient Greece when disease was thought to spread from "miasmas," or foul-smelling gas that came out of the ground.

With this new quarantine effort in the news, we offer a look at quarantine use — and abuse — over the ages.

Bubonic plague in Venice (1370)

The so-called Black Death killed 20 million Europeans in the 14th century. So Venice, a major trade port, grew nervous. If a ship was suspected of harboring plague, it had to wait 40 days before any passengers or goods could come ashore. Venice built a hospital/quarantine center on an island off its coast, where sailors from plague-infested ships were sent either to get better, or, more likely, to die. This 40-day waiting period became known as quarantinario, from the Italian word for 40. As opinions about the disease changed, the isolation period shrank to trentinario — 30 days — but the original name stuck.

Yellow fever in Philadelphia (1793)

Almost 5,000 people died over the course of two years, about a tenth of the city's population. Thousands fled for the countryside, and at the height of the epidemic, when nearly 100 people were dying every day, the city government collapsed. Philadelphia was the capital of the country, but the federal government evacuated rather than face the scourge. The best known cure at the time was to "bleed" patients of infected blood and give them wine — and a popular theory on stopping the disease was to quarantine sailors at the Lazaretto, a hospital outside the city. But the disease is spread through mosquitoes, so quarantine was not as effective as the cold snap that eventually killed the infected insects.

Typhus in New York (1892)

In 1892, a boat carrying many Russian Jewish immigrants arrived at Ellis Island. Passengers in steerage class had developed such bad cases of body lice that the harbor inspector declared he had "never seen a more bedraggled group," according to medical historian Howard Markel. Lice led to typhus, but by the time that disease was discovered, the passengers had spread out to boarding houses and family homes across New York's Lower East Side. At least 70 were rounded up and quarantined in tents on North Brother Island in the East River. An outbreak of cholera followed in New York, from a ship bringing more Russian Jewish immigrants. According to Markel, the front page of The New York Times ran a piece saying, "We don't need this kind of riff-raff on our shores," referring to Russian Jews. It wasn't an op-ed, he notes.

Bubonic plague in San Francisco (1900)

City authorities strung rope and barbed wire around a 12-square-block section of Chinatown (after allowing all Caucasian residents to leave). The cause: fear of bubonic plague, after a Chinese immigrant was found dead in a hotel basement. The quarantine was lifted after a few days, but not before countless Chinese laborers had lost their jobs. This "bubonic bluff," as it became known in the press, prompted ugly discussion — never put into action — about mass deportation of Chinese immigrants.

Typhoid in New York City (1907)

You've probably heard of Mary Mallon, better known as "Typhoid Mary." She was an Irish-born cook who carried the bacteria that causes typhoid fever, a form of salmonella that can cause fever, diarrhea and death. But Mallon herself was immune to the disease. When authorities figured out that her work as a cook had caused the city's typhoid outbreak, she was sent to North Brother Island for a three-year quarantine. She promised never to cook for others again. But she broke her word. (She was especially fond of making peach ice cream.) When apprehended in 1915, she was sent back to the island for the rest of her life — 23 more years.

Venereal disease in the United States (1917)

With World War I raging, the U.S. military became concerned about the number of young men ineligible for the draft because of sexually transmitted diseases like syphilis and gonorrhea. They also noticed an uptick in "camp girls," prostitutes and other women hanging around U.S. training grounds and military recruitment centers. A federal order allowed for the incarceration of prostitutes and camp girls until they were deemed STD-free via mandatory testing. Harvard University medical historian Allan Brandt estimates at least 30,000 women were picked up in raids. "There's no evidence that this impacted the rates of transmission," he says. "But there was this notion that these women constituted a serious threat to our success in the war." He notes that while the women were being rounded up and held in prison, often long after they'd tested negative, the Army was issuing condoms to soldiers shipping off to France.

Flu epidemic in Europe and U.S. (1917-1919)

This global pandemic, which killed an estimated 50 million, prompted quarantine and isolation, as well as school cancellations in Europe and a ban on public gatherings in parts of the U.S. These methods merely held the disease at bay temporarily and were "hugely socially disruptive," according to medical historian Markel. Influenza is one of the most contagious diseases in the world. A few minutes with a patient who is coughing and sneezing can be enough to transmit the disease. For comparison, Markel says, you'd need to spend eight hours with a tuberculosis patient to be infected.

SARS in Canada (2003)

Though the severe acute respiratory syndrome (SARS) pandemic of 2003 led to quarantines in many different countries, Canada's response was the most disproportionate to the risk. According to the U.S. National Institutes of Health, Canada quarantined almost 100 people for every confirmed SARS case in the country. Though Toronto only had 250 probable cases, about 30,000 people were confined in hospitals and their homes. A comparable number were quarantined in Beijing, which had 2,500 cases.

Bubonic plague in China (2014)

China took a page from San Francisco's turn-of-the-century playbook when it faced a single case of the bubonic plague. A man died of the disease after feeding a dead, plague-infected marmot to his dog in the northwestern city of Yumen. Over 150 people who had contact with the man were placed in quarantine; several districts of the city were sealed off, isolating thousands. Yanzhong Huang, a fellow for global health at the Council on Foreign Relations, said in an interview with The Guardian, "SARS taught Chinese leaders ... the wrong lesson — that quarantine was the magic bullet in addressing any major infectious disease outbreak." After two days, the quarantine was lifted; no other cases were reported.

Ebola in Liberia and Sierra Leone (2014)

In Liberia, the neighborhood of West Point was cordoned off for 10 days in August after residents raided a center for suspected patients. Patients fled into the densely populated slum, prompting the government's decision to isolate the neighborhood for 21 days, the incubation period for the disease. Protests ended the quarantine after 10 days. In neighboring Sierra Leone, a three-day quarantine in September asked everyone to stay at home while health workers went door to door, looking for the sick and delivering bars of soap. Doctors Without Borders, the medical organization that played an important role in the fight against Ebola, said, "It has been our experience that lockdowns and quarantines do not help control Ebola, as they end up driving people underground and jeopardizing the trust between people and health providers."

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