History of Quarantine in the United States: Origins to Modern Day

Introduction: The Apollo Quarantine and the Meaning of Isolation

In 1966, during the summer, the U.S. Congress closed debate and passed approval for the construction of a laboratory that would be used to confine the astronauts and the materials they brought back from the moon. Congress approved NASA's budget for the project in 1966, and the laboratory was completed in September 1967. This was a major step forward in the history of the American quarantine system. The center was named the Lunar Receiving Laboratory (LRL), located at the Lyndon B. Johnson Space Center. The project arose from fear of back-contamination from the astronauts and the material they carried from the moon.

The process was straightforward. After the crews of Apollo 11, 12, and 13 were recovered from the sea upon landing, they were taken directly from the helicopter to a waiting isolation vehicle on the aircraft carrier deck and flown to the LRL for isolation.

This isolation of the astronauts was viewed as a preventive measure against any potential danger or incidental contamination. It was not carried out upon confirmation of any assured back-contamination from the moon. In fact, in all three Apollo quarantine cases, no serious threats were detected, and the astronauts were released to continue with their daily lives. The principle behind the quarantine was, and remains, more important than the findings that followed.

Definition and Origins of Quarantine

Quarantine is a voluntary or compelled isolation, ordinarily used to control the spread of an infection or disease deemed lethal to a population. The disease may be considered sufficiently contagious to warrant isolation. Isolation periods range from very short — as in cases of anthrax exposure, where a victim can leave as soon as contaminated clothing is removed and a decontamination shower taken — to considerably longer periods while laboratory results are awaited. Quarantine has undergone massive advancements and today encompasses quarantine ambulances, mobile dispensaries, hospitals, and full lockdowns.

The word quarantine originates from the Italian quarantena, quaranta dei, or quaranta giorni, all of which literally mean a forty-day period. This forty-day period was historically observed when ships arrived at the dock of another country and there was suspicion that they came from an area with active plague. These days were considered sufficient for the authorities to confirm that none of those aboard was infected. Though this method was not watertight — since fleas, rats, and cockroaches could still carry plague into the new country — the practice of quarantine continued. The mass holding of people offshore for forty days continued for quite a long time, until the mid-twentieth century, when antibiotics were discovered and vaccinations were offered to visitors in place of wholesale detention.

Quarantine has been practiced since biblical times. In the Old Testament, there is clear evidence of lepers being isolated from the rest of society. The laws governing the "unclean" were designed to protect others from contagion. Lepers were placed outside the camp, and their remaining clothing was torn and burned (Leviticus 13:45–46). This was one of the harshest early forms of quarantine, as lepers were considered cursed and unclean. The practice continued into the New Testament period and beyond.

History of Quarantine in the United States

Quarantine law in America effectively began during the colonial period in 1663, when a smallpox outbreak led New York to establish a law entrenching the isolation of infected persons. By the 1700s, all major cities and towns along the eastern coast of the United States had passed quarantine laws, though enforcement was typically triggered only when an epidemic proved especially lethal. For instance, a 1701 Massachusetts law stipulated that all those infected by plague, smallpox, or any other contagious or transmittable disease must be isolated in separate rooms.

In 1738, New York faced its first major test of quarantine when it was struck by smallpox and yellow fever. The city council decided to build a quarantine station on Bedloe's Island, which became the holding station for arriving ship crews suspected of carrying contagious illness. Philadelphia faced a similar crisis in 1793 when it was hit by a yellow fever outbreak of comparable — if not greater — magnitude. Consequently, in 1799, Philadelphia built an expansive isolation station called the Philadelphia Lazaretto quarantine hospital in Tinicum Township, Delaware County, Pennsylvania. At that time, Philadelphia was still the capital of the United States.

The hospital occupied a ten-acre strip of land along the Delaware River, and the structure still stands today. That same year, the colonial legislature passed the first United States quarantine enactment on February 23, 1799, and federal officers were subsequently required to help enforce it. This marked one of the earliest significant developments in the formal quarantine system of the United States.

Following outbreaks of varied epidemics in the Caribbean, the Mediterranean, and several other tropical regions in 1808, the Boston Board of Health ordered that from May to October of each year, any vessels from those regions would be held off the bay until they had completed a 25-day period since departing their respective ports. New York reinforced quarantine measures in 1832 after cholera killed close to 30,000 people in Britain. Ships were held at a 300-yard radius from the dock if the captain knew of cholera cases aboard. Unfortunately, the infection slipped through the barrier and killed close to 3,500 residents of the city before it subsided in September.

Following heavy outbreaks of cholera and other infections in Europe, Egypt, Turkey, and elsewhere, New York City introduced a new Quarantine Act in 1863 that established a quarantine office under a health officer with the legal mandate to quarantine any ship entering New York City for as long as the officer deemed necessary. The officer could also order cargo removal and ship fumigation. This authority was soon tested in 1866, when the cholera-ridden steamer Virginia docked in New York from Liverpool with 35 passengers and 2 crew members already dead. The New York health officer ordered a swift quarantine and medical attention, limiting the death toll to approximately 600, far fewer than the thousands who had died in previous epidemics.

The Rise of Federal Quarantine Authority

Within a decade, the need to address quarantine at a national level became pressing. The first national quarantine act came into effect on April 29, 1878, mandating federal officers to execute state and municipal quarantine rules. The following year, the U.S. Congress established the National Board of Health amid fears of a yellow fever outbreak. The board was intended to supplement state quarantine efforts, but it was dissolved in 1883 after failing to carry out its mandate and running short of funding.

The 1890s ushered in the era of bacteriology, driven by extensive scientific research following numerous epidemic cases in the United States. Scientists had determined the life cycles of various pathogens, enabling health officers to calibrate the length of quarantine periods accordingly. In 1892, President Benjamin Harrison, through his Surgeon General, announced that no foreign ships would be allowed to dock in the United States unless they had undergone a quarantine hold of twenty days or more and had been cleared by state authorities.

The following year, Congress passed the National Quarantine Act, which created a national quarantine structure while still permitting state-managed quarantine. The act also stipulated procedures for inspecting foreign ships, immigrants, and cargo — functions that the Marine Hospital Service then carried out at the federal level.

With the turn of the century came more concrete developments. In 1902, the Pan American Sanitary Bureau was formed, one of the first international health organizations of the twentieth century. Its purpose was to elevate quarantine and disease control to the international stage. Barely a year later, the New York City Department of Health established a quarantine facility on North Brother Island at Riverside Hospital, aimed at providing an isolation area for tuberculosis patients.