Quarantine and Isolation: A Brief History of Public Health Measures Against Infectious Disease

“From isolation in the home to the closure of public spaces, history contains many pertinent lessons in the control of infectious disease.”

By now, most of us are no strangers to the idea of quarantine. “Self-isolation” and “social distancing” have come to be the new normal for many people all over the world as we attempt to arrest the spread of the COVID-19 pandemic. Staying home as much as possible, keeping away from hospitals and health centres, not travelling outside the country, working from home, and other measures which all seem new and unprecedented in our own lives are no strangers to history– as we implement different forms of quarantine today, it is useful, and perhaps imperative, to look back at their origins in the diseases we have fought in the past.

Quarantine and isolation, as we have all no doubt seen, come in many different forms. From isolation in the home to the closure of public spaces, history contains many pertinent lessons in the control of infectious disease. What follows is a brief history of some of these methods of quarantine and the diseases for which they were used.

The Black Death: Sanitary Cordons and Lazarettos

In the years 1347-1352, the Black Death plague was at its peak in Europe.[1] The disease was a terrible one, killing 30-60% of the European population.[2] It was caused by the bacterium Yersinia pestis, and was transmitted to humans through fleas and rodents.[3] During this time, there was not an awareness of germs as the cause of disease (the germ theory of disease would not be truly accepted until the latter half of the nineteenth century through the work of scientists and doctors like Louis Pasteur, Joseph Lister, Robert Koch, and others). Mainly, disease was thought to be caused by many different possible culprits, including miasmas, or bad air, an imbalance of humours, poisoning, or divine punishment.[4]

Plague Doctor
A 17th century representation of a plague doctor’s costume (print from the Museum of Health Care’s Collection)

However, quarantine measures were still put into place in an attempt to prevent the spread of disease. Sanitary cordons, which consisted of armed guards blocking transit routes and access to cities, were imposed, and could be punishable by death if broken.[5] Healthy people and infected people were separated, and plague doctors wore long leather cloaks and masks lined with wax and a long “beak” filled with herbs or sponges soaked in vinegar to ward of miasmas.[6]

Additionally, goods were quarantined for fear that they might transmit the disease (fabrics were a particularly suspected culprit), and were ventilated, some being immersed in running water for two days.[7] Later on, in the fifteenth century, lazarettos were created, comparable to nineteenth century isolation hospitals.[8] Lazarettos were places to quarantine the sick or suspected carriers away from the city, where they would not risk infecting healthy citizens.[9] While people during the time of the Black Death did not know the correct reason that quarantine was useful in the prevention of disease, their methods of quarantine informed, and continue to inform, later public health measures.

Isolation: At Home, In Hospital, At Borders

Currently, patients with COVID-19 are being urged to stay away from hospitals unless necessary, in order to avoid infected vulnerable patients, including the elderly and those with compromised immune systems. Quarantine in the home is the best option to prevent the spread of disease. This is not a new idea, as we can see from the numerous quarantine signs in the Museum of Health Care’s collection. People with infectious diseases and their families were required to place signs like these in their window to ward off visitors and warn of the presence of disease in order to prevent its spread. They could only be taken down with the permission of the Board of Health.[10]This strategy was used for a number of diseases, including typhoid, whooping cough, cholera, scarlet fever, smallpox, measles, and others.[11]

Measles and Wooping Cough Signs
Quarantine signs for Measles (018010004) and Whooping Cough (018010005)  from the Museum of Health Care’s Collection.

Another strategy employed in order to prevent the spread of disease was isolation in hospital. Isolation hospitals were built specifically for the purpose of housing patients with communicable diseases in a separate building from other patients. In 1923, the City of Kingston built and began running an Isolation Hospital, which housed patients with tuberculosis and other infectious diseases.[12] This hospital replaced the earlier “Shack,” built originally to house tuberculosis patients, and was succeeded by designated spaces in Kingston General Hospital in which patients needing isolation could be housed.[13]

Shack
The “Shack” in 1906 (photo courtesy of the KGH Archives)

Quarantine, however, is not restricted to the home and the hospital. We recently saw Canadians quarantined at CFB Trenton after returning from travel abroad, and history shows that quarantine for those coming into Canada from abroad is not a new practice.[14] Among the more famous examples is the quarantine station at Grosse Ile, an island in the St. Lawrence River near Québec City. There, beginning in 1832 and lasting until its closure in 1937, immigrants (especially Irish immigrants) were quarantined for a time until being released to begin their lives on the continent. There exist numerous records of the lives of people who passed through the Grosse Ile quarantine station on their way into Canada; people were born, baptised, died, and some were even married on the island.[15]

Tuberculosis Sanatoriums

Tuberculosis Sanatoriums
The Muskoka Cottage Sanatorium, 1897. Regarded as the first sanatorium in Canada, it is easy to see from this glass slide photograph(From the Museum of Health Care’s Collections, 1976.41.1) the strong emphasis on isolation and fresh air. 

Tuberculosis sanatoriums present a kind of isolation different from that of other diseases. Isolation was not only used to prevent the spread of disease to the healthy, but as part of the cure itself. The Sanatorium was a place during the late nineteenth and early twentieth centuries where tubercular patients went to “take the cure.”[16] “The cure” consisted of hours of daily bed rest, light exercise, fresh air, and sunlight.[17] Visitors were very restricted at the Ongwanada Sanatorium in Kingston in 1948, visitors were only permitted to stay a maximum of three hours four days a week, with the other three days being limited to an hour and a half.[18] Children under the age of fourteen were not permitted to visit on the wards at all.[19] Absolute rest and as little excitement as possible were considered essential in the proper treatment of tuberculosis, and isolation from the world outside the sanatorium helped to achieve this, as well as preventing the spread of the disease to others.

Today, tuberculosis patients are often treated at home, taking a regimen of medications in order to be cured. Not unlike the current pandemic, patients are encouraged to remain at home as much as possible until a test reveals that they are no longer contagious.[20]

The Closure of Public Spaces and Government Aid

The Spanish Flu occurred in the years 1918-1920, right at the end of the First World War, and was a devastating disease. It killed an estimated 50-100 million people worldwide, including approximately 55,000 Canadians.[21] Most of the victims were between twenty and forty years old, in the prime of their lives, and the virus affected even rural communities.[22] Like today, municipal and provincial governments attempted to stop the spread of the disease by closing public spaces and prohibiting gatherings, and health care workers remained on the frontlines, risking their lives to help the sick.[23] People looked to their governments for guidance and help during the pandemic, but were disappointed by the lack of federal coordination and provision of resources, prompting the creation of the federal Department of Health in 1919.[24]

1918 Field Alberta Spanish Flu
Men in a field in Alberta during the fall of 1918. They are wearing masks in order to prevent the spread of the Spanish Flu. (Photo courtesy of Wikimedia Commons)

What Can We Learn From All This?

While no two pandemics are exactly the same, there are lessons we must take from the public health crises of the past in order to best manage the current COVID-19 pandemic. The Black Death taught us to limit travel and sanitize goods. Infectious diseases like cholera, typhoid, and smallpox taught us to quarantine at home, in hospital, and at borders. Tuberculosis treatments taught us to stay home as much as possible and limit contact with others. The Spanish Flu taught us to stop public gatherings and to organize in order to prevent the spread of disease. With history as our teacher, and if we stay home and practice public health measures, we can make COVID-19 just another thing of the past.

About the Author: Shaelyn Ryan

Shaelyn

Shaelyn Ryan is an undergraduate student Queen’s University, starting her forth year in the Bachelor of Arts History Program this fall. Either as a Summer Student or Work-Study Student through Queen’s University, Shaelyn has helped catalogue and research many of the museum’s collection of artefacts as a Collections Technician (since 2018).

Citations

[1] Eugenia Tognotti, “Lessons from the History of Quarantine, From Plague to Influenza A,” Emerg Infect Dis. 19, no. 2 (February 2013).

[2] Dr. Hanna MacKechnie, “The Great Famine and the Black Death Plague,” (lecture, Queen’s University, Kingston, ON, March 12th, 2020).

[3] Ibid.

[4] Ibid.

[5] Eugenia Tognotti, “Lessons from the History of Quarantine, From Plague to Influenza A,” Emerg Infect Dis. 19, no. 2 (February 2013).

[6] Eugenia Tognotti, “Lessons from the History of Quarantine, From Plague to Influenza A,” Emerg Infect Dis. 19, no. 2 (February 2013).; “Beaky Plague Protection,” Deutsches Historisches Museum, accessed March 26th, 2020, https://www.dhm.de/blog/2017/07/27/beaky-plague-protection/.

[7] Dr. Hanna MacKechnie, “The Great Famine and the Black Death Plague,” (lecture, Queen’s University, Kingston, ON, March 12th, 2020).

[8] Eugenia Tognotti, “Lessons from the History of Quarantine, From Plague to Influenza A,” Emerg Infect Dis. 19, no. 2 (February 2013).
Ibid.

[9] Quarantine Notices for Typhoid Fever, Whooping Cough, Measles (018010003-005), Museum of Health Care at Kingston, Research Collection Catalogue.

[10] Ibid.

[11] Lorna Knight, Archivist for Kingston General Hospital, email to author, January 17th, 2020.

[12] Ibid.

[13] Belleville Intelligencer, “Quarantined Canadian at CFB Trenton tests positive for COVID-19,” Ottawa Citizen, March 11th, 2020, https://ottawacitizen.com/news/local-news/quarantined-canadian-at-cfb-trenton-tests-positive-for-covid-19/.

[14] “Immigrants at Grosse Île Quarantine Station, 1832-1937,” Immigration Records, Library and Archives Canada, last modified May 25th, 2018, https://www.bac-lac.gc.ca/eng/discover/immigration/immigration-records/immigrants-grosse-ile-1832-1937/Pages/immigrants-grosse-ile.aspx.

[15] Information and Rules for Patients, Ongwanada Sanatorium, Kingston, Ontario [information booklet] (004028031), Museum of Health Care at Kingston, Research Collection Catalogue.

[16] Ibid.

[17] Ibid.

[18] Ibid.

[19] “Home Isolation for Tuberculosis (TB),” Health Link BC, last modified August 2017, https://www.healthlinkbc.ca/healthlinkbc-files/home-isolation-tuberculosis.

[20] “The Spanish Flu in Canada (1918-1920),” Parks Canada, last modified March 25th, 2020, https://www.pc.gc.ca/en/culture/clmhc-hsmbc/res/doc/information-backgrounder/espagnole-spanish.

[21] Ibid.

[22] Ibid.

[23] Ibid.


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